Having no answers at times

[mulyantiapollo]

A calm night it was, a colleague of mine is taking care of a post-op patient after spine surgery. We had a good night and the patient was fully conscious with GCS-15/15, jolly and communicating well his concerns to the medical team. This gentleman was the most stable patient in ICU for overnight monitoring. He had a chest tube because of a pneumothorax. It was no longer draining any air after the 12 hours in ICU. He was not able to feel the lower limbs before and after surgery. But we had hope that he will improve after the operation. We always offer a bed bath in the morning and he was informed about it. As my fellow nurses were bathing him, his wife came in and talked to him but he told her that he was not breathing well but she was told to move out to give the nursing team space to do their work. The patient stopped breathing within 3 minutes and a CODE was called. He was resuscitated for over 2 hours but no ROSC. I know most of you now are guessing the diagnoses which might have causes the 50 year old man die despite of all our efforts. The post-mortem report said there was no much that was found to have caused this gentleman to die. This left us guessing and wondering what could have taken his life. We made so many diagnoses as you have made so far but nothing pointed at what caused death in this patient. Sometimes, as nurses us get traumatized when a patient dies and no conclusive diagnosis that points to what caused the patient to code and leaves fear in our hearts always. The lesson learnt is that any patient can die any time and however much the cause is known the patient is dead. Many questions but no answers at times.

[Susie2310]

I noticed after writing my post that you practice in Uganda. So, please disregard my comments below, as, not being in the US, they do not apply to you.

[icuRNmaggie, BSN, RN]

Dear Mulyanti,

The first thing that would come to mind is a pulmonary embolism. This can happen even with mechanical and chemical prophylaxis for deep vein thrombosis. Even with the very best care it can happen and it something that you could not have foreseen or predicted. You could not give tpA to a post operative patient to break a blood clot in the lungs.

Another possibility is that that chest tube was accidentally pulled out from the pleural space and that resulted in a tension pneumothorax and pulseless electrical activity from hypoxia. But as you said many diagnoses but no conclusive answers.

Any sudden unexpected death is a shock for the hospital staff. It sounds like you did your very best and every thing possible for this unfortunate man.

[Lev, MSN, RN, NP]

I was thinking of pneumothorax as well. PE is also a possibility after any surgery especially where the patient is immobile as this one was. (((HUGS))) Sometimes things happen where we can't see the reason. You did everything that you could have done.

[mulyantiapollo]

We made all these diagnoses but the postmortem showed nothing pointing to the obvious causes that we thought caused this patient to die.

[Dial9first]

You make no mention of past medical history or comorbidities, like diabetes, HTN, COPD, etc........... Could not feel his legs prior or after surgery? Sounds like that cause should have shown up.....(Aortic dissection).