ICU new grad, handling an emergency successfully

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Specializes in Critical Care.

Since choosing Pre-Nursing as my major I knew I wanted to be a critical care nurse. When I landed a position in the cardiac ICU I was ecstatic - this was my dream job. Still, the thought of handling emergencies was terrifying. One thing that helped me prepare was reading stories of how other nurses did it. Here's one of mine.

78year old M patient with a hx of COPD CAD CHF DM HTN HLD Afib admitted for shortness of breath and chest pain. Found to have 100% occlusion in a carotid artery. Complications arose during treatment and he ended up intubated & on a balloon pump. For my shift the patient is 2 days off balloon pump and 1 day extubated starting dialysis d/t fluid overload, non-responsive to diuretics, high BUN & creatinine. Lethargic but A&O, afebrile, V-paced, BP 130/78, pulses palpable, on room air, lungs diminished in bases, very low urine output, heparin gtt infusing.

All through my shift this patient slept or watched tv, c/o mild generalized pain but no chest pain or shortness of breath. Sleepy, but that is expected d/t dialysis and it being night time and all. Lack of urine production I also attributed to dialysis that evening, and that was his trend for the last several days.

I was helping another nurse bath a patient around 5AM. When I left to grab a gown I peaked into my two patients' rooms: one was sound asleep, all vitals WDL, but the 78yr old was desatting to 88%...87...86.

I woke him up. His eyes shot open in surprise. I asked how he was doing and he said he was just fine. He was still A&O, but pursed lip breathing and his belly was moving with every inhale. I placed a nasal cannula and cranked it to 6L. "Are you having any trouble breathing?"

He took a few more breaths before responding. "I think... I don't know. Maybe a little."

I raised the HOB to 90 degrees and called Respiratory and the on-call Resident. LS and were the same but I still suspected fluid overload since dialysis hadn't remove much. Respiratory and Resident agreed. Bipap was placed. Bumex was ordered. I pointed out the crappy renal function. The resident still wanted to try it. I suggested labs. ABGs and a lactate was ordered. The tech and I stuck the poor guy 8 times before I decided to go for a subclavian vein with success. His hands were growing cooler. A short while after sending labs I received a call for critical values: PH 7.1 & Lactate 17.

I told the Resident and then pinned down the patients arms as he was trying to rip off the bipap. I asked for the charge RN's help but she on the opposite side of the unit with another decompensating patient. Great.

The Resident called the attending. Before I knew it, the patient's BP was 68/30, and I was slamming in a liter of fluid, pushing 6amps of bicarb, starting a norepi & vasopressin gtt, infusion Zosyn, and preparing the patient for re-intubation and A-line placement. Cardiogenic shock vs mesenteric ischemia was in question.

It amazed me how quickly this guy turned. He is still sick but vitals are under control. I left that day feeling okay and thinking, "For a new grad nurse 9 months in, I didn't do too bad there."

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Specializes in Clinical Research, Outpt Women's Health.

Great job!

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Specializes in Ortho.

Thanks for the story!! It does help us new nurses starting out. I'm not there yet....but will be soon. 1 week until I graduate and then the NCLEX. :yes:

It sounds like you did an awesome job....for any nurse!! That patient was lucky to have you.

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Nice read but. You and the tech stuck the guy 8 times? Wow that's a exorbitant amount.

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Specializes in Critical Care.
Nice read but. You and the tech stuck the guy 8 times? Wow that's a exorbitant amount.

lol i'm still a new grad. my sticks - and other skills - aren't perfect, especially when i'm trying to collect blood from a guy going into shock ;)

other nurses looked and couldn't find anything so didn't try, but i REALLY wanted that lactate

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Specializes in Clinical Research, Outpt Women's Health.

You did a great job,but on sticks....2 and done. Get someone else after that.

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Thank you for sharing your story! It helps us as new grads to think like a nurse! Great job!

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Specializes in Critical Care, Education.

Echo PPs - you did a great job. However, please think twice before posting such a detailed account of an actual patient encounter. If anyone 'knows' who you are, this could easily end up as a major HIPAA violation.

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Specializes in Family practice, emergency.

Such a good feeling!

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I have one better. I won't go into too much detail but I had a patient start to have hematuria and crashed right in front of me. Incubated, Central Line, EGD. 6mm varices need to get repaired. I had 7 different iv's going into this guy. He made it but the story was that I was only in the ICU covering because they were short staffed that day. I normally work in Tele. pH and CO2 will tell you when to intubate. Oh, and I was only a nurse for 9 months.

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I'm sure the least of that patient's or the patient's family's worries was the number of "sticks". Finding someone else to do it off unit or even on the unit where I'm sure everyone was busy with their own critical care patients would waste valuable time. While excessive for a patient who wasn't in an emergent situation, I feel you handled this nicely! I start on an IMC unit in two weeks; I can't wait to work in critical care. Great job and thanks for sharing your story!

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Thanks for sharing your story!!! New grad here waiting to take NCLEX, I read your story wondering and hoping I could react calm and collected!

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