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Just Melted Away

Emergency   (2,043 Views 6 Comments)

NurseOnAMotorcycle has 10 years experience as a ASN, RN and specializes in Med-Surg, Emergency, CEN.

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I've been having recurring dreams about a patient that we had a while ago. For the most part, when a patient comes in you can take one look at them and see what you are in for.

This one was a new one for me.

A patient was called in to our attending by her cardiologist so we were expecting her. She came into the trauma bay as a middle aged cardiac evaluation, achy but talking and able to transfer herself from the stretcher to the bed. In minutes, she was in a gown and complaining of back pain. A newer nurse told them "let us do what we have to first and then we can get some pain medication for you."

I saw the pt's pale sweaty face and hands, noticed that she was now only A&Ox1, and tersely told New Nurse to grab the providers quick because her kidneys were shutting down. In an instant they arrived with respiratory and more nurses, and we began mega-coding this pt who came in mobile, talking and a little sore.

As I watched, her vitals slipped lower and lower. I called them out every few minutes to the provider who watched the heart rhythms on the zoll, "Systolic 64. O2 70." Another ACLS medication would be ordered while they attempted intubating, "systolic 61, O2 68," RT continued CPR, bloodwork was drawn, and a third IV inserted to push fluids.

"Systolic 68, O2 70," I said hopefully, recording another set of vitals and another ACLS medication given, "systolic steady at 68, O2 71." We are going to save this one. This one is going to live.

We pumped, we pushed meds, we shocked, we pushed more medication. After about 45 minutes from the patient's arrival, the attending doctor called it.

"Time 0213."

I'll never forget it. 0213. I knew her for just under 45 minutes, and I'll never forget it.

The family wasn't surprised. They knew what I didn't. Her heart had long been very damaged and had deteriorated until it "was basically just jello anyway."

I really thought we were going to save that one. But we couldn't.

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Altra is a BSN, RN and specializes in Emergency & Trauma/Adult ICU.

6,255 Posts; 40,456 Profile Views

The ones that come in talking can be really hard. Wishing both of you peace.

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LadyFree28 has 10 years experience as a BSN, RN and specializes in Pediatrics, Rehab, Trauma.

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The ones that come in talking can be really hard. Wishing both of you peace.

:yes:

(((((HUGS))))

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54 Posts; 2,473 Profile Views

I had one last Jan. Came in walking and complaining of pain and feeling "awful" but couldn't tell me where or be any more specific. Currently being treated for breast ca, 2 days s/p first chemo ( that she told me was elective). + nausea and vomiting. We treated her pain and nausea.

She was anxious - which is what I wish I would've paid more attention to - the significance of anxiety. I also knew her - she was friends with someone I knew, had met her a few times and we had talked about our kids.

2 Hours later she has near syncope while walking to bathroom. Then she says it. Actually, yells it.

" I feel like I am going to F-ing die"

Sats drop, gets tachy. sats drop more and she gets intubated, then she codes. I re-live it often. Every word that she spoke before we tubed her. I have the picture in my head of when she walked into my room just hours earlier.

Likely a huge PE. Before my shift ends I am getting texts from mutual friends to tell me that she died. I knew, cause she was my patient.

It made me a better nurse. Those anxious patients with vague complaints with very subtle vitals get my attention. Because I know now that patients can walk in and not walk out. I don't think that getting a CT early on would've changed the outcome, but it would have felt better if we knew what was happening. It is probably the only scenario that still runs through my mind often, at first it came with a wave of guilt and sadness, but now I take it as a lesson and let it go.

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26 Posts; 1,259 Profile Views

I remember when I was fresh off of orientation. EMS brought in a guy who woke up throwing up blood. He was 86. No family around. AOx4. In about 10 minutes he was hypotensive. He agreed to let us give him blood but was a DNR. I couldn't get the blood in fast enough. I kept asking him questions about his life so i could keep him taking. With in 25 minutes he became confused. Then he became asystolic. I held his hand while he took his last breath. No family to call. Just me and him in the room. I said a little prayer and then began to clean him. I thought about it every day for about a month. I still think about him. I hope I made his last moment on Earth as peaceful as possible.

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Lev has 7 years experience as a BSN, RN and specializes in Emergency - CEN.

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Newer ED nurse here, but I have learned quickly to never ignore the vague complaints of "I don't feel so good" especially from people with many comorbidities.

Sorry this happened to you.

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