The Pre-crash hint

Pete495 · Apr 4, 2005

Happens more often than not on my unit. That is part of the reason I am leaving, and trying to become more autonomous. It pisses me off to no end, let me tell you. All you can do is make your case known, and document, document, document. Unfortunately, the patient is the one that suffers. At my hospital, we don't have Residents on our unit, and not many other docs, so we just deal with a select few, so when they blow you off, you have nothing else left.

I remember one patient not too long ago who was an OPCABGx3, did well for the first two days, then for the next two just looked like crap, nothing specifically wrong, but was less and less responsive for the next 3 days. well, she eventually ended back up on a vent, then coded and died. our nursing staff had told the doc. several times, but we were ignored. This just goes to show you that ignorance is not bliss when you are on the receiving end.

PJMommy · Apr 4, 2005

Your timing on this post is ironic. I just had one of these on my last two shifts. We all just *knew* things weren't right. He looked like crap, his gases sucked, his labs were way out of wack, he was becoming less responsive. On my fifth phone call to the doc, he started again to brush up my concerns and I stopped him and said "you need to come down here NOW". (He was sleeping in the call room.) I swear he didn't recall any of my previous calls to him that night...."ohmigosh, his calcium is really low" -- uh, yeah, I think I stressed that when I called you with a critical value THREE HOURS AGO! The pt died several hours after my shift ended.

Yeah, I did document, document, document. But honestly, it still breaks my heart that, as a nurse, I can do everything right and I'll still have to hope that a clueless, bonehead doc doesn't drop the ball. And then, of course, I play the was-there-something-else-I-could-have-done? game. It's a tough game.

barefootlady, ADN, RN · Apr 4, 2005

You ladies deserve a pat on the back because you do care and continue to care even when the docs just don't. Please do not eat yourself up with guilt, you did your job and did it well.

Toby's mum · Apr 4, 2005

Anybody ever had a patient for a couple of days or nights in a row who gave you a hint that they were about to go South like a sudden though compensated drop in BP or rhythm pause that you told the docs about and they weren't concerned and then the next day the pt totally crashes? This is the second time this had happened to me and the docs are like, well why didn't you insist MORE and I'm like yo, look at my progress note I told you people THREE times the night before when he dropped his BP momentarily and you didn't care cuz you had a code on the burn unit!

I work as a cardiac monitor tech on a 32-bed telemetry unit. The other night we had a patient who seemed like he was doing better. He was historically sinus brady in the high 50's. However, around 8:30 pm his heart rate went up to 120-140 and he was lying in bed not moving. The nurses checked his BP, which was sky high. He promptly had a seizure AND acute MI by 9:00pm. So within 30 minutes the guy went into trouble. However, the heart rate was the first sign of trouble--it was so different (and double) what he usually experienced and this was without visible exertion. He didn't code--but was taken to the ICU/CCU after that. Two days later his troponin's came back at 52! It's amazing how quickly someone can go down the tubes.

madwife2002, BSN, RN · Apr 4, 2005

I work on a neuro ward and yesterday one of my patients suddenly went 'off' nothing specific, slight rise in BP headache and c/o feeling unwell. Bleeped Dr who said 'am not coming to review because if he is extending his stroke, there is nothing i can do for him anyway' End of story !!!!!

my2sons · Apr 11, 2005

Pallor, in an otherwise pale or normal colored patient. Even worse-- the pallor and diaphoresis combo. I had a hunch with a 3 day post Reopro MI doing ok, vitals good, but his color was off. Asked MD if I could do a H/H on the guy. Doc looked at the patient, then back at me like I was nuts and said no. As soon as the doc left, I drew a H/H that came back 5/16. Hung PRBCs, notified the doc (who was pi##ed that I drew the blood, by the way.) An hour into his transfusion, the patient vomits a huge amount of bright red blood AND has a massive burgundy jelly BM. That doc learned a lesson that night: never underestimate the hunches of an ICU nurse!

humglum, BSN, RN · Apr 11, 2005

Bleeped Dr who said 'am not coming to review because if he is extending his stroke, there is nothing i can do for him anyway' End of story !!!!!

Oh my, that's a telling statement. I don't know what I would say to that. Even if the doctor couldn't FIX him, he still has the obligation to address changes in condition.