My first rapid response (Sorry, this is long)

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Specializes in med-surg.

I have been on a med/surg unit for seven months now. I have seen 2 codes and 1 rapid response in the past, but those patients were not mine. I helped out with one of the codes and the adrenaline rush was amazing. I thought to myself, "Oh yeah, I definently want to do ICU or ER work someday."

Well, I told myself that before it happened to my own patient.

I arrived to work last night and noticed that there was a code happening in one of the rooms near the nursing station. I sat there sipping my coffee watching the nurses and the doctor work frantically trying to coordinate intubating the patient and doing compressions. I thought to myself, "Wow. They look like they are horrified. I am glad that isn't my patient."

I got report and was told that one of my patients was a 23 y.o. male that was admitted 4 days ago for polypharmacy drug overdose and resp. failure. He was in the ICU for two days, and last night was the end of his second day on our floor. He was suppose to be discharged the next day (today) to a methadone rehab. He is an ex-heroin user, and a benzo addict. The nurse gave him 1mg of IV Ativan (for withdrawl) at 1800 and she said, "I think the 1 mg was too much for him because after I gave it, he was dozing off as I was talking to him. Oh and he desats to the low 80's if he isnt on O2." she explained that they had been working on pulmonary toileting and a pulmonologist had been in to see him today. Then I got report on my other pt's, 2 of which I was familiar with and had them the previous night.

I started off first by seeing my first patient; a fresh post-op that got up to the floor at 1700, and she has a running Epidural. Did my assessment, documented, and moved on to my next patient...the 23 y.o. male with respiratory issues.

I walk into the room, he is laying down and snoring very loudly...and slowly. I walk up to him, calling his name and he is not responding. As I approached him, I thought, "Is he...cyanotic?" I reached down and touched him, still calling his name, and he still wasn't responding. I look and see that he pulled off his nasal cannula and had it bundled up in his hand. Then I look up at the continuous pulse ox (that wasn't beeping) and his HR was 174 and his O2 was 62%. I called a rapid response and froze. "Oh ****!"was all I could yell (thank God it was just me and the unconscious pt in the room or I'm sure there would have been consequences for that). I pulled it together enough to run to the supply room, grab a non-rebreather mask, run back to the room and put it on the pt. I was applying pressure to his nail beds, yelling his name, doing everything I could think of at the time, just so my pt would wake up and talk to me.

The ICU nurse came in, along with the RTs, and she immediately did a sternal rub and the pt nearly came out of the bed. A response! Success! Now why didn't I think of that? He was transferred to the ICU and as far as I know, is still alive.

Since a code JUST HAPPENED, we had no Ambu bag on our floor since they used it. Also, the day shift nurse neglected to set up the continuous pulse ox correctly...it wasnt plugged into the wall and transmitting data to the computer at the nursing station where our unit secretary can see it. Plus the pulse ox was defective and not beeping when sats drop below 88%. Having a mechanical breakdown like that was infuriating. But walking into my patients room to see him cyanotic and barely breathing was the worst feeling ever. Whew! What a night! and it was only 2000. LOL....

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Specializes in Critical Care, Education.

Congratulations - you handled this situation very well for someone with your experience level. You may not realize it, but this single event taught you more in a few minutes than you could have learned in hours of formal education.

I guarantee you - in the future, you will react differently when you are faced with a somnolent/unresponsive patient & you'll remember to try a sternal rub to rouse them; you will remember to check pulse ox connections; you will always be conscientious about restocking and replacing equipment after a code. To top it all off, you have taken the time to reflect on the event and your actions -- which means that you have learned from the experience. As a nurse educator, I am SO PROUD of you!!! You're well on your way to becoming an expert.

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Specializes in NICU, PICU, adult med/surg, peds BMT.

Good job.

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Specializes in critical care, PACU.

good job. I am shocked though that you dont have an ambubag in every room! maybe you can suggest this? At every hospital Ive worked at or been a student at it was always required.

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Specializes in ED, ICU, lifetime Diabetes Education.

You did a great job! Ditto on what fiveofpeep wrote about not having an ambu-bag in every room.

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Specializes in pulm/cardiology pcu, surgical onc.

It is a scary thing when it's your patient. I had a pt with abd pain who had h/o etoh abuse, smoking and needed bipap but refused to use it. I walked her to the br at 0600 and she wasn't quite right so I got her vs when back into bed. I was going to check her bp 1st but just as a hunch checked her sats and they were 47%. yikes! It turned out fine she went to icu and was discharged from there. I know it may sound callous but I hope that the pt uses that hosp experience as a wake up call (i know i did!) to take better care of herself.

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Specializes in med-surg.
good job. I am shocked though that you dont have an ambubag in every room! maybe you can suggest this? At every hospital Ive worked at or been a student at it was always required.

When I was a Nurse Apprentice in NV while going to school, we also had ambubags in every room. I will definently ask our educator about that. I also thought that it was odd that we only had one on the whole unit! It's weird that I don't think about these things until I actually need them.

Also, although we have suction equipment in every room, we don't set the suction up in all the rooms; only for seizure precautions, r/o CVA/TIA, and aspiration precaution patients.

I know it may sound callous but I hope that the pt uses that hosp experience as a wake up call (i know i did!) to take better care of herself.

You know, I was thinking the same thing about my patient. Being a 23 y.o. with all these health issues, mainly because of drug abuse. It really does break my heart. but because of the experience he gave me, I know I will be more prepared from here on out. I was fumbling around like a lunatic. Sheesh.

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Specializes in stepdown RN.

I'm suprised you said you were sitting there sipping coffee watching the nurses and dr. code a patient. If that was me and I was early for work I would have clocked in early. Even if I didn't help with the code I would have covered the patients that weren't getting attention because everyone else was in the code.

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Great job!

I remember when I did my first sterum rub where the pt didnt respond. I looked up at the monitor and her HR was 47, checked pulses and they were gone. Pt in PEA. I jumped on the bed and started doing compressions and screaming for help.

You will never forget this experience.

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Specializes in Medical Surgical Orthopedic.

I am slightly worried that you disclosed so many specifics about your patient....but anyway, I'm glad that you walked in when you did. Yikes! It's hard to sleep after a night like that, isn't it? :eek:

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