your first "patient emergency"

[pinkiepieRN]

I've called "rapid response" on patients before, but never on anyone in my direct care. Today, my patient called out, complaining of n/v. I came in, and although I didn't note anything funny, there was something about him that just didn't seem right. I questioned him as to what was going on and he spaced out. Just like that, the right side of his body started twitching. Instinctively, I looked at the clock as I told the CNA to get another nurse. What followed actually flowed pretty perfectly in my opinion. We got vitals, he stopped seizing after ~5 minutes, I called the doc, filled out paperwork and gave him a stat dose of Dilantin, with labs to be drawn in the morning. I was certain that I would have been more freaked out at the onset of the seizure, but I stayed calm.

I hope that he's either better when I get back on Tuesday or they ship him out (I'm in LTC/rehab). Either way, I came home knowing that I made a difference today!

I was in psych before, so I've handled "behavioral emergencies" but nothing medical like this!

Anyone else want to share their "first"?

[akulahawkRN, ADN, RN, EMT-P]

I remember my first "patient emergency" like it was almost yesterday. While I was not a nurse at the time, I was most certainly in a patient care role…

This patient is now long gone, at the time she was 93 years old in a board and care facility. In fact, this was a 911 call. The fire department got there, did their assessment, they were BLS, as were we at the time. According to their assessment, she was unconscious, unresponsive, was breathing, and had a pulse. By the time I did my assessment, she was VSA. In other words, she was in full arrest, and a full code. She was also my first CPR patient. I called the code, started compressions, got the firefighters to assist with moving the patient to our gurney, and we initiated transport to the local hospital, where we continue to work the code for a long time, probably forty-five minutes or more. She did not survive despite our efforts.

What I did take away from that experience is that even though I was very new at the time, I was trained well enough to not panic and get things done. I have since worked quite a few codes, and most of them have blurred with time... There are, of course, a couple of memorable ones but along the way I have certainly come to understand that I simply just do not panic during an emergency and I just do what needs to be done.

Clearly though, most of those did not occur in a very short period of time, rather that all took place over the course of some seven years of service in EMS. Fast forward a few years later and I still do not panic during an emergency. It does however give me a very good perspective when some of my classmates have had their own. In my opinion one of my classmates, in doing a very good assessment of his patient, prevented the code and called the rapid response team to assess his patient and had he not done so, I think the patient ultimately would've had a very poor outcome from the get-go. Given the situation and the fact that he had never been in any sort of emergency situation before, I think I actually was prouder of him with his decision that I was of me making similar decisions in the past. Perhaps that was because he is still in a student mode of thinking and at the time I was already working in EMS, fully trained and expected to perform at a fairly high level.

[blackvans1234]

I have two ''first'' patient emergency's. Both as a PCT, so my role was assisting.

First emergency- I was working on an inpatient rehab unit, our patient was an older italian guy, it was just after change of shift, maybe 8pm. He had been resting in his bed without making a fuss, and being rehab, let our patients rest once in a while . As the nurse walked by the room, she saw that Mr. Jones' foot was hanging out of the bed, went to move it back into the bed and couldn't arouse the Pt. I overheard her saying to call a rapid. He was a diabetic so I grabbed the VS machine and the Glucometer. She told me to check the glucose. Got the glucose and it was 130. Darn. Vitals were not anything crazy abnormal. They pushed narcan because the nurse reported this patient was sensitive to narcs. Pt became arousable.

First REAL emergency- Got floated to CCU for the first time.- Quick note- It seems that anytime there is a developing emergency and I am doing another task, I have the most difficult time doing the task (even though completely unaware of the emergency- I'll explain a little later). I was doing glucometer testing for a patient, and totally smudged the drop of blood by accident. As a result, a miniscule amount of blood entered the strip, and the glucometer gave an error reading. I put a new strip in, the first stick had clotted so I grabbed another needle. Right as I turn back towards the patient, the nurse is at the doorway directly across the hall leaning out and yells, "We're calling a code here people!!!" I put the needle down and speed walked into the room. I was the second one there. The nurse that had yelled outside had started compressions on this vented patient. I told him "I got compressions" and he let me take over compressions. In a matter of maybe 60 seconds(I remember counting up to 120 compressions), the code cart was in the room,respiratory was there disconnecting the vent and bagging, a nurse was putting the Defib stickers on the patient (I remember learning in my BLS course- Let everyone work around you, do not stop compressions for any reason). They shocked the patient, I continued compressions. Got tired so a nurse took over. Left the room to finish the blood glucose. Pt was revived. About a week later I saw the patient on PCU, still vented.

[Lennonninja, MSN, APRN, NP]

I'd say my first real emergency was a patient on my med/surg floor having a heart attack. I'd been a nurse for maybe 6 months at this time. It was not at all what I expected it to look like, and if the doc hadn't physically looked at the patient he wouldn't have believed the tele and 12 lead saying he was infarcting. Got the patient rolled out to cath lab right at shift change, and luckily I'd done an internship on the pre/post cath lab floor so I knew how to explain it all to him already. Felt pretty good about the whole situation actually!

[Vespertinas]

I tell him ok here it.........asystole. Pt went slump stopped breathing no response.

WHAM hammer fist to the chest. Pt wakes up and says "where did I go just now?"

Love this story but I wanna ask are you sure it was actually asystole?

(sorry to ruin it with nitpicking)

[Vespertinas]

My first emergency.... a renal transplant patient who experienced a transfusion-related acute lung injury (TRALI) which is basically an immune-mediated flash pulmonary edema. Uh yeah I totally panicked. I mean within a few minutes she went from talking to me, to having an itch in her throat (which I incorrectly was addressing as reflux), to being unable to breathe, to being intubated. It all happened so fast and being that it was a respiratory code and not a cardiac I wasn't even sure how to operate.

My educator took me aside after pt was shipped out and started to debrief me. My lip started quivering and she warned, "oh no you don't." That pretty much did it; I was such a ball of nerves and I let it all out right there in front of my hard-as-nails smokers-voice ICU-worn twice-divorced educator. Gold.

[K+MgSO4, BSN]

I was a student in Ireland where final year students were used to cover shortages in staffing if they passed various hurdles.

I was covering an RN on nights with another nurse who I did not like because she got easily distracted and hyper anxious. We did our night round me and the hca doing obs pads turns and she did meds.

There was a pt that I had been looking after for over a week general medical pt. She point blank refused her meds from this nurse so I took them and tried to convince her to take them. No luck.

She was boarding in the resp care unit as there was no other bed to move her to. Another pt in the RCU was on NIV psych hx life long smoker agitated from hypoxia. Kept pulling off her BiPaP. So I was in and out to her all night. I checked on all 3 of the other pts in the unit each time I was in.

One time I went in to reapply the NIV yet again and swung my torch over the other pts. My pt was not breathing. Went over, turned on the light. Checked for a pulse (remember when BLS recommended that?) Yelled for help.

The nurse came in with the trolley and started flapping with the BVM and the portable Oxygen tank that was on the trolley. I grabbed it off her attached it to the wall oxygen and bagged while telling the hca to open the 3rd drawer to get out a gudel airway. At this point I was telling the nurse to do compressions. She just stood there. I YELLED at her do CPR. At this point the night matron walked in with the crash team behind her. She jumped on this pt chest as the hca was clearing room.

I thought I would be in trouble as I was seen yelling at a nurse when a student by the night matron. Nope after it was all over (pt rip) she complemented me on my quick thinking and contacted the uni and put a recomendation on my file!

The nurse was still flapping around and freaking out even after I had spoken to the family with the doctor and the night matron.

In the morning the NUM heard all about the episode from the matron and the CCU nurse before he hit the ward. I think they stood at the 2 enteances to the hospital to catch him!

[nurseprnRN, BSN, RN]

I tell him ok here it.........asystole. Pt went slump stopped breathing no response.

WHAM hammer fist to the chest. Pt wakes up and says "where did I go just now?"

Love this story but I wanna ask are you sure it was actually asystole?

(sorry to ruin it with nitpicking)

I'm thinking if the WHAM to the chest worked it was probably VT/VF (no pulse, of course), but still-- great save.

[Munch]

This is the emergency I remember the most vividly. I was working at Memorial Sloan-Kettering cancer center at the time(I lasted a year..it was too sad plus I lost my father to cancer so it was a double whammy..anyway I digress about my career moves).

Anyway we had a lung cancer patient (this is at MSK) who just finished his last round of chemo to try to shrink the mets that spread in his brain. It was successful and he had surgery to remove brain mets. He had spent about 36 hours in the NSICU then they transferred him to my floor. His biggest complaint was nausea and vomiting (not uncommon after surgery, plus the chemo he was getting..cisplatin I believe it was, and it has delayed nausea and vomiting as a side effect). He also had A LOT of pain and stiffness in his head (he couldn’t lift his head off the pillow yet. They had him on a 75mcg Fentanyl patch Q 48hrs, 8mg Morphine IVP Q 2hrs, Lorazepam 2mgs IVP Q 4-6hrs PRN, 10mgs Reglan IV in 50ml bag of NS Q 6hrs and Dexamethasone IVP starting at a dose of 8mgs(I think…like I said this was years ago so some of the dosages and frequencies might be a bit off but the medications I am positive of).

I figured with the reglan, lorazepam and dexamethasone he should be covered with the nausea and vomiting. He was also given a one-time dose of Inapsine about three hours before I came on. I checked on him at around 10pm, he was still nauseated and still stiff so I left to ask the doctor if maybe we could add a muscle relaxant to his regimen. At 10:20 his neighbors call bell went off(I wasn’t taking care of his neighbor, another nurse was) and she came running to get me saying my patient was going to crash if something wasn’t done, I ran there along with two doctors and two other nurses to find my patient vomiting uncontrollably. The problem was he was flat on his back and unable to turn to his side due to his surgical incision. So he was basically drowning in his own vomit. We tried to roll him to his side, but his sats were dropping and his airway needed to be cleared. They decided to paralyze and intubate him but things were going from bad to worse as the doctor couldn’t see the cords because their was vomit EVERYWHERE. I really thought we were going to lose this patient who just forty-five minutes ago was talking and cracking jokes with me. Thankfully the doctor was finally able to get the tube in and no long-term damage occurred. They transferred him up to the MICU.

Last I heard from a friend at MSK he was still alive getting experiemental treatments for his cancer.

[That Guy, BSN, RN, EMT-B]

I tell him ok here it.........asystole. Pt went slump stopped breathing no response.

WHAM hammer fist to the chest. Pt wakes up and says "where did I go just now?"

I'm thinking if the WHAM to the chest worked it was probably VT/VF (no pulse, of course), but still-- great save.

Well the monitor made it look that way, of course could have been very fine vb. Either way, no pulse no response scared me to death as a student ha ha

[sharpeimom]

I'm not sure if this one qualifies, because it wasn't life threatening, but it sure scared the heck out of me!

I was a very new nurse and my patient was a man in his early seventies, who had spent decades doing missionary work in Africa.

He had scleroderma and his feet were very very fragile. He was African American and his feet were a combination of very dark skin

and silvery white very tightly stretched skin. He had absolutely no sensation in his lower feet or toes.

After he had had his breakfast, I helped him wash and get cleaned up. I changed his bed while he sat in his chair. He went back to bed, still telling me the most fascinating stories about the people he'd worked with. He shifted his legs and my eye automatically followed. He very cheerfully went on talking. Suddenly, I realized that his little toe was all by itself apart from his foot on the sheet!

Since he hadn't noticed what had happened yet, I quickly excused myself and went and found my mentor.

[K+MgSO4, BSN]

^^^^ I remember that happening to me. I had got my pt out of bed, pulled the sheets off and a toe dropped out!

[nurseprnRN, BSN, RN]

I had one come off in my hand once while I was dressing the ulcer on the heel ... eeesh.