I work on Interventional Cardiology/Cardiac Step down. I just got home from one of the worst nights any Nurse or MD has ever had.. I work at an inner city hospital that is one of the top cardiac hospitals in the US. Pt. was talking to me and another nurse when pt. said chest felt heavy and pt turned blue and stopped breathing, I looked at the monitor the HR went to 280 v-tach, pt's ICD was firing out of controll, then pt. went into pulseless V-tach then full out cardiac arrest pt's only 57 y.o.. we shocked the Pt. 50+ times over 4 hours , CPR cracked a bunch of ribs, ambu bag and this went on for 4 hours..pt. went in and out of pulseless v-tach. Respiratory Acidosis, we pushed so much NaHCO3 that we ran out of it from the code cart med tray which we had 2 of them and the pyxis supply.Who evver invented ACLS is my hero .Interventional MD put a Aortic Baloon in at the bedside..we used 2 code med trays we pused more drugs into that pt. than any MD said they ever had, drips galore, 3 pumps with 3 channels per pump..that's 9 drips I think, TLC placed in groin after 10 attempts, ABG's x's I don't even know how many,tubed the pt only for the pt. to start foaming at the mouth, then vent at the bedside..CCU had no open beds, the EPS MD was caled 30 min. into the code he was at home, he said he was doing 110 MPH on the garden state inorder to get to the hospital. one MD wanted to call TOD 30 min. into the code..we said no, then they realized that they had only been shocking the pt at 200 joules b/c I looked at the defib. machine and said Hey we might wanna shock him at 360 joules, ((ya think))..this all started at 8:30 pm. Great way to start my shift. We finished the code at 1:30 AM!!!! We cracked 3 ribs, MD's burnt the crap out of the pt's chest from the defib. paddels. cath lab on call was activated..Pt went to CCU, 25 min after pt was in CCU he was AAOx3..still tubed in Normal Sinus...I was happy that we didn't let the one MD call TOD..the family hugged all of us and said they are going to write a letter to the hospital and say how we saved the pt's life and didn;t give up when the one MD wanted to call TOD..the family asked for my name and said that if it wasn't for me pushing the fact that the pt had only been coded for 30 min. and we weren;t going to give up untill the EPS MD arrived and we were going to do every thign we could for the pt., the family said that the pt. had gone through this before at another hospital..that actually felt good that the family said we saved his life. But 30 min after our code was over there were 3 more codes in the ICU...the EPS MD said that was the longest code he ever had in his 20+ years of medicine and thanked all of us..he asked if it was my first mega code..I have been in codes before but nothing like this..he gave me a hug and said I can't even tell you how greatful I am that you didn't let the code team give up on this pt, and that you opened your mouth and wouldn't give up, he asked how long I have been a nurse, I said about 9 months. The MD said that there should be more nurses like me in our hospital. I was totally shocked he said that..I said thank you so much...needless to say I am BEAT!!:heartbeat:heartbeat
acls now says on biphasics to shock at 200 not 360 that was for the old monophasic...you might make sure which machine you have in your unit just to make sure...
Specializes in CTICU, Interventional Cardiology, CCU.
ok HERE I GO AGAIN...so at 0615 this morning I was just checking on all of my pt.s when one of the nurses screams my name to come help, she found her pt. unresponsive with little to no pulse, and not breathing. I had this pt. previously this past weekend, so I knew the pt. and pt. only spoke spanish, which I speak a little. The pt's a screamer b/c pt's in a private romm b/c of MRSA and is lonely so when I didn;t hear the pt. screaming I knew something was VERY wrong. And just to note I am no longer the new girl on my floor( I have 9months) we got a new orientee thay just graduated in december to nights shift, it was her first code she was like a deer in headlights, that was me a few months ago. Anyway I ran picked up the phone called the code and jumped over the nurses staion and into the room and jumped on top of the pt. who was morbidly obese and began compressions It was probably the worst possible person you could do compressioins on. Thank god there happened to be a respirstory therapist on the floor and it just so happened when we called the code the Head cardiologist was just walking onto the floor to make his rounds. He ran the code, the pt. hooked up to the defib. pulse of 15, pt.s completley edematous, like anascarca, atropine, epi, bicarb, the nurse taking care of the pt. had not seen the pt. at all, all night. I had stopped in the pt's room around 0400 to say hi b/c I had the pt 3 nights in a row and knew the pt., pt. smiled at me grabbed my hand and said alot of info in spanish I caught..Pain..pain..asked the pt to point to the pain, it was in the leg,so I had told the nurse, she didn't do a da** thing, she went back to charting and said to me, "oh pt's fine" I said no pt is not fine pt. in alot of pain, told my charge nurse which is not like me but I had that GUT feeling that something was wrong 2 and a half hours before the code..pt. is s/p fem bypass surgery and s/p Left foot amputation, and pt. probably has CHF, and now b/c of the neglect all night b/c the nurse didn;t check on the pt.probably has a PE and is intubated and I hope to god the pt. makes it through the day. So back to the code, I have the ER cart memorized now so I was the ONLY one who knew where everything was, so at this point the craziness calms a little bit people begin leaving the room b/c it's shift change and it's only me and the respiratory therapist at this point where's the pt's nurse I have no IDEA, I got a pressure it was 140/45..wide ..but bettter than before..ok not more then 2 minutes later I get another pressure it's 60/30, I begin screaming for everyone to get back into the room and not to leave untill the situation is undercontroll, the one MD asks for dopamine drip..and I must have titrated it like 10 times b/c the pt's pressure was going up and down And the nurse walks back into the room ,I said "what was the pt's blood sugar this monring", she says to me, "well last night it was 70 so I just gave a skim milk.I didn;t check t this morning." I was ready to scream..I get the sugar it's 80 so I pushed D50, we try to do a 12 lead EKG can't get a reading but on the bedside monitor and on the defib monitor it looks like peaked t waves, I tell the cardiologist, labs still arn;t back yet, couldn't get an ABG to save our lives b/c of the edema. So we didn't know what the K+ was, sidenote pt. had high K+ of 6 this weekend when I was the nurse, I gave kayexelate and it came down to 4.Anyway FINALLY the BP stablizes. The family is there at this point. The respiratory therapist and the Cardiologist said to me, "You are the only nurse that knew anything about this pt. and you are only one of a few the nurses that can run a d*** code on this floor the right way". I said "can I get that in writing cause I am one of 6 canidates for an ICU job here at this hospital", they said to me "I would be glad to stand by your side during a code anyday"..I hope that the pt. gets the care the pt. deserves..It made me so mad that the nurse just ignored the pt. b/c never rechecked the blood sugar and ws no where to be found during the code. This is a nurse with 20+years experience. I now know I have the ability to run a code the way it shsould be done. I don;t know if it's just my presonality but anytime something goes wrong the first person they as for help is me. That is encouraging b/c The last few weeks have been that point where I am over my first 8 months of nursing..I think this morning it just clicked and I know I want to either tranfer to the ED or the ICU, pray that I get the ICU job!!!!
Morettia2 you have had some exciting things happen. Be cautious though in revealing too much information about your location and your patient. The recall did involve one brand's leads, but a situation where there was such a sentinel event is not the norm.
Also please break your post into a few paragraphs. Trying to read 20 lines in one block is very difficult.
Specializes in CTICU, Interventional Cardiology, CCU.
Morettia2 you have had some exciting things happen. Be cautious though in revealing too much information about your location and your patient. The recall did involve one brand's leads, but a situation where there was such a sentinel event is not the norm.
Also please break your post into a few paragraphs. Trying to read 20 lines in one block is very difficult.
I am so sorry I know it is hard to read and I apologize. I just start typing and try to get it all out. I THANK GOD for this site every day so I can read and post and get feedback...thanks so much for the response!!!:wink2:
One question..........and Im smiling while Im asking, but how is he A&O X3 while he is intubated? :). Nice work. It makes all the other BS you have to deal with worth it when you perform something so amazing. Non medical people have no idea what that feels like. Keep it up.
:wink2:
cdktRN
15 Posts
acls now says on biphasics to shock at 200 not 360 that was for the old monophasic...you might make sure which machine you have in your unit just to make sure...