Pt survives DESPITE ordered tx!

[ceecel.dee, MSN, RN]

Just read thread about ridiculous overtx of possible allergeric rxn potential and thought this might be an interesting topic!

We had a pt in with a tachyarrythmia, IV bolused with Ca+ channel blocker x2 and one oral dose. 6 hours later, bradycardic, quite hypotensive, to ICU, overnoc no void, renal failure, blood sugars >600, insulin gtt, dopamine gtt, elevated TroponinI, Heparin gtt, bloody urine, GI bleed. Poor man was so good natured and his family so thankful for all we did. One of those cases we didn't feel really good about.

Did survive us, but worse for wear!

Transfered to regional heart center for cardiac and renal specialists. Cardiology report said Ca+ channel blocker dosage was appropriate, no way to gauge how this man reacted to it. MI probably occured during tachy phase and culmination of all resulted in bradycardia, hypotsn, renal failure. We (our doc and us nurses) still felt bad about it.

Anyone else have patients who survive/thrive in spite of what's been done 'for them' in the hospital?

[oramar]

Pt had bowel perforated during colonoscopy. Showed signs of sepsis pretty quickly. Taken to surgery, everything fixed up fine. Pt. went home healthy.

[fedupnurse]

In some cases, it isn't what was done, but what wasn't!! Sometimes we feel like we have to beat doctors to get appropriate orders. We don't have a dedicated intensivist which is our bigges problem. We call it "death by multiple consultations". All the specialists look at their organ and no one but the nurse is looking at the whole picture. Kinda scary for a regional referral center type medical center huh?????

[l.rae]

Evey day! Had one that didn't,,,,intubation gone WAY bad

LR

[ceecel.dee, MSN, RN]

Nancy, we have the same problem here, except with GP's (no intensivists here). Sometimes want to say "give me that order sheet!, rather than 'milking' out the orders needed in the 'right' tone of voice, with innocent expression so they think it was their idea.