My god, I saved a life for the first time!

[guest042302019, BSN, RN]

I've been volunteering in the ER for nearly 3 months now. And, I have seen a great deal, but nothing as compared to tonight. Normally in a typical night, I will clean rooms and stock various cabinets with Saline solution, absorbant pads, etc. However, tonight I was part of a tragic experience that turn into a living saving one.

Because I have built a relationship with the staff in the ER, I am able to participate in more than a typical volunteer gets to do. With that being said, this is what happened. I was chatting with a nurse, and she asked me if I would like to assist her while she gives one her patients some medication. Her patient was very nice, and I talked with her prior to my invite to help, while I was cleaning the bed next to her. She was likely upper 50s, early 60s. She had a son that was a bit older, so I'm just guessing her age, for I have no idea what it was. In the patient's case, she had extremely high BP at staggering 235/150. WOW, right? As a result of her high BP, she was prescribed a vasodilator, but in her case, this medication was a rather rare type. So rare that the nurse and the charge nurse had to look up the proper drip rate, etc. After doing so, I assisted the nurse in punching in the drip rate in the machine that does it for the nurses, as apposed to them manually adjusting the rate. I don't know the name off hand of the machine. Anyway, after we completed the medication initiation, I decided to clean an empty room a patient had just vacated. After I was done cleaning, I stood my post just in sight of the board of names in case another name crossed off, relaying to me to clean another room. I stood there for a few minutes and for no particular reason, I decided to go check on the woman that I had helped a few minutes earlier.

I walk in," Hey, how are you doing? Can you feel the medication making a difference?" I said something similar to that, and I stood by her bed, and immediately, I notice something "isn't quite right." I say "Hey, how are you feeling?" with a little louder voice. Now for the record, this woman was very outgoing, enthusiastic, and friendly, however, she lied there with an absolute expressionless face. Nothing in her face showed any type of recognition where she was, or what was going on. I stood there observing her for a few moments. And finally, she incoherently said,"OK." This seemed incredibly odd to me because I didn't ask her a question that prompted an "OK" answer and she said "OK" much later than my line of questioning. Then, she began to droop her head down, and slightly twitched, with a faint groan in her voice. I didn't wait any longer, I ran to the nurse and relayed my observations. She promptly hung up the phone she was talking on, and ran to her room. She immediately tried to get a response out of the women, which failed drastically. She demanded I go get the doctor, which I did without a second thought.

Now, at this point, I was calmer than I would've have thought I would be, say a couple months ago. But, I walk up to the doctor, and say," 1L is out of it!!" I didn't know the medical jargon, and she was confused in saying,"What??" So I said,"1L NEEDS HELP NOW!!!!!!" With a curse under her breath, the doctor speed into the room along with a couple nurses. She began to administer simple sensory-motor tests on the woman in order to bring about a response. At first, nothing happened. This is the weirdest part to me. With the vasodilation medication in her system, the patient's BP dropped to a semi-normal BP of 140/90, which is still a bit high, but better than before the medication. BUT, her respiratory rate had dropped to a meager 13. And, her chest was in an "expanded" position as if she stopped in the middle of an inhalation of oxygen. I don't understand how the vasodilator could have such an affect. Maybe there was a drip rate/dosage error? Maybe an unbeknownst allergic reaction that occured? Maybe the vasodilator worked "too good." But even if it worked too good, wouldn't that drop her BP, and not her Repiratory rate? I don't know, for I don't have the medical knowledge to understand this concept.

Anyway, after several nurses came in, and did a fine job in team-work and coordination, the patient came out of her brush with death, she was immediately sent off for a CT. I left the ER shortly after because my shift was at its' end.

We all have what ifs? What if I didn't go in the room at all? What if I went in the room a few minutes later than I did? What if the patient didn't come out of her daze at all? What if she died? What if the nurses made a mistake choosing the drip rate? What if this or what if that?

Needless to say, I can say that I did save this woman's life because my innocent stroll into her room. Among other things, this occurence has definitely cemented my choice in the Nursing career, because this feeling of sheer satisfaction I have is what all the hard work, and even, brushes with death is worth. Situations like this makes me wonder "Was there divine intervention, or mere chance?" Personally, I don't put much stock into faith into a higher power, but something like this, really makes me wonder, was there other forces at work?

-Andrew

[Dinsey]

Wow, what if the nurse didn't have you "help" administer medications? What exactly does it mean that they let you do more than a usual volunteer? Patient care is NOT in the scope of practice of a volunteer. Did you actually touch the IV pump?

I'm glad the patient is ok, and it's nice that you're still interested in nursing, but it seems like a very dangerous situation. The hospital could be in a lot of legal trouble if unlicensed personnel, especially a volunteer, "assisted the nurse in punching in the drip rate in the machine"

[nursel56]

Thank you so much for sharing your experience, Andrew! It says an awful lot about you that the nurses trust you enough to ask you to assist them as they are taking care of their patient.

It's hard to pinpoint what caused the lady to droop and exhibit signs that her level of consciousness was heading downhill. With all the fancy technology and monitors and telemetry, etc. sometimes is all boils down to the eyes and ears of another person! That "spidey sense" that something "isn't quite right" can be your best friend as a nurse!!

This is a variation of "treat the patient, not the numbers" and has saved many a patient's life, and has saved many a nurse or doctor's as$ as well.

It's pretty exhilarating to know your intervention in calling for the nurse right away grabbed the woman "out of the drain" Lord knows that when you finish school, you'll be seeing many discouraging, sometimes tragic, things go on especially if your ultimate goal is to work in the Emergency Department.

Hard to say what prompted you to check on the lady. The point is, you did. Best wishes to you!!

[Katie5]

Wow, what if the nurse didn't have you "help" administer medications? What exactly does it mean that they let you do more than a usual volunteer? Patient care is NOT in the scope of practice of a volunteer. Did you actually touch the IV pump?

I'm glad the patient is ok, and it's nice that you're still interested in nursing, but it seems like a very dangerous situation. The hospital could be in a lot of legal trouble if unlicensed personnel, especially a volunteer, "assisted the nurse in punching in the drip rate in the machine"

Praise him first- he did help save a life....THEN caution him on that.:)

[ParkerBC,MSN,RN, PhD, RN]

Thanks for the story. I hope you do consider going into nursing as I think you would make a great asset to the team J

[guest042302019, BSN, RN]

Wow, what if the nurse didn't have you "help" administer medications? What exactly does it mean that they let you do more than a usual volunteer? Patient care is NOT in the scope of practice of a volunteer. Did you actually touch the IV pump?

I'm glad the patient is ok, and it's nice that you're still interested in nursing, but it seems like a very dangerous situation. The hospital could be in a lot of legal trouble if unlicensed personnel, especially a volunteer, "assisted the nurse in punching in the drip rate in the machine"

When I say assist, I don't literally touch the IV pump, but I'm just there in observance. As far what I do more than a typical volunteer, I will help lift patients onto beds from paramedic's flat board once they arrive, some other basic stuff. Ofcourse, they don't allow me insert an IV, asses, etc. :)

[guest042302019, BSN, RN]

Thanks for the story. I hope you do consider going into nursing as I think you would make a great asset to the team J

Thanks, and I intend to! I received my acceptance letter a few weeks back. I'm starting the program in the fall.

[guest042302019, BSN, RN]

Thank you so much for sharing your experience, Andrew! It says an awful lot about you that the nurses trust you enough to ask you to assist them as they are taking care of their patient.

It's hard to pinpoint what caused the lady to droop and exhibit signs that her level of consciousness was heading downhill. With all the fancy technology and monitors and telemetry, etc. sometimes is all boils down to the eyes and ears of another person! That "spidey sense" that something "isn't quite right" can be your best friend as a nurse!!

This is a variation of "treat the patient, not the numbers" and has saved many a patient's life, and has saved many a nurse or doctor's as$ as well.

It's pretty exhilarating to know your intervention in calling for the nurse right away grabbed the woman "out of the drain" Lord knows that when you finish school, you'll be seeing many discouraging, sometimes tragic, things go on especially if your ultimate goal is to work in the Emergency Department.

Hard to say what prompted you to check on the lady. The point is, you did. Best wishes to you!!

Thank you, and it sure seemed like the 6th sense lol After being in the ER, I am convinced that is where I want to be. I have witnessed the awful occurences. Little children in car wrecks. Gun shot wounds. Stabbings. Actually, last night a patient died with a brain aneurysm. Very sad, but I think what makes a good nurse is the ability to whole-heartedly compassionate, while also being objective during the real bad traumas. Both of these qualities, I do believe I have, and I am looking forward to exercise them!:redpinkhe :redpinkhe

[Emergency RN]

Even though her resultant pressure of 140 x 90 was still marginal for a normal person, one has to remember that she normally lives at a much higher range. Years ago, the treatment modality was to mistakenly drop the persons BP back to what is considered a normal range. When a lot of people had strokes because of it, they found that BP's for certain patients who had extreme BP's needed to be gradually returned to normal. By dropping too much too soon, it deprived their brains of oxygen and in fact, induced ischemic cerebral infarctions (strokes from lack of oxygen).

The current thinking is to lower the BP by no more than 25% of the presenting pressure. Since the patient presented at 235 systolic, the target pressure would be around 170's or so. By dropping it suddenly to 140, she no longer had enough blood pressure to push into an arterial system that was conditioned to resist against her usual systolic jolt of 230's. In other words, she no longer had enough pressure to push blood into her brain. Her confusion that you witnessed was the result of oxygen deprivation.

In this case, what they need to do is to stop the medicine immediately, lay her head down and give her plenty of oxygen, allow her BP to return to a higher range, and then resume the medication at a much lower dosage if at all. Frankly, she may do better at this point with a by mouth medication instead, as it would not lower her pressure so suddenly (as an IV drip can do if not monitored carefully).

And yes, it was serendipitous that you happened to have returned to her room. Good luck with your future nursing career.

[nursel56]

Praise him first- he did help save a life....THEN caution him on that.:)

That's what I was thinking, too.

[guest042302019, BSN, RN]

Even though her resultant pressure of 140 x 90 was still marginal for a normal person, one has to remember that she normally lives at a much higher range. Years ago, the treatment modality was to mistakenly drop the persons BP back to what is considered a normal range. When a lot of people had strokes because of it, they found that BP's for certain patients who had extreme BP's needed to be gradually returned to normal. By dropping too much too soon, it deprived their brains of oxygen and in fact, induced ischemic cerebral infarctions (strokes from lack of oxygen).

The current thinking is to lower the BP by no more than 25% of the presenting pressure. Since the patient presented at 235 systolic, the target pressure would be around 170's or so. By dropping it suddenly to 140, she no longer had enough blood pressure to push into an arterial system that was conditioned to resist against her usual systolic jolt of 230's. In other words, she no longer had enough pressure to push blood into her brain. Her confusion that you witnessed was the result of oxygen deprivation.

In this case, what they need to do is to stop the medicine immediately, lay her head down and give her plenty of oxygen, allow her BP to return to a higher range, and then resume the medication at a much lower dosage if at all. Frankly, she may do better at this point with a by mouth medication instead, as it would not lower her pressure so suddenly (as an IV drip can do if not monitored carefully).

And yes, it was serendipitous that you happened to have returned to her room. Good luck with your future nursing career.

That's fantastic explanation. I had planned to learn the underlying cause next Saturday, when I volunteer, but you pretty much summed it up. Your experience is evident in your writing. Thanks for your time.

[fiveofpeep]

what a great experience for you and I really hope the pt turns out ok.

did they do any stroke type neuro assessments on her...like did you notice hemiparesis (weakness on one side) or facial droop or unequal pupils? these are also things you can learn to add to your toolbox so you dont just run on a "spidey sense". there is a whole NIH Stroke Scale you can do too. You can check it out here if you are interested: http://www.ninds.nih.gov/doctors/NIH_Stroke_Scale.pdf

You are in such a lucky position to get to be around all of this. You will learn so much. Just keep and eye out for how these nurses and mds respond to these emergencies and you will have some experience for when they happen to you :)