My Patient Coded Yesterday

I'm a new grad nurse. I have been on the floor for three weeks, yesterday marked the last day of my third week into my orientation process when my patient coded. I am on a Med/Tele floor caring for 3 patients but my preceptor is monitoring the tele strips (I'm not ekg certified yet).

Out of my three patients I had one "problem child" and two patients admitted with fractured hips. The one I was leased concerned about was the gentleman with a hip fracture who was alert and oriented. He was the one who coded and it came out of NO WHERE right in front of my vary eyes. I gave him a multivtamin and asked him if he was interetsed in getting the flu vaccine. He said he was. I went to the pyxis to get the vaccine, came RIGHT BACK and while I was trying to find the lot number on the vaccine vile, he started complaining of being too hot. He didn't look right. Diapheretic and loosing his color. I checked his temp: normal. Called my preceptor and told her to come immediately. She happened to be in the room next door and dropped everything to come help me. Then her tele phone started beeping and we were told his HR was 33.

Called the doc, doc ordered 500cc bolus of NS. For about 15-20 min we administered the bolus (he was a frail 95 y.o. male with a 20 gauge IV). BP and HR started to get better and we thought we were in the clear... Then he started tanking again and stated "I don't want to do this anymore". Another nurse ran into the room who was monitoring the ekg strip from the nurses station and said "He doesn't have a P wave!"

My preceptor called the doc and told him he needed to come ASAP. We called a code on him and before I knew it, 2 docs, 2 RT's, 2 flight nurses (came to try and get a better line in him), 2 ICU nurses and several nurses on my floor swarmed him. He was a full code. They cracked open the code cart and started a dopamine drip on him, got a stat echo, and put the pads on his chest, all of this was a blur and I could feel my heart beating in my chest. When he was stable enough, he was taken down to Cath lab.

That day, his triponins were 1.29, so he was put on 12.5mg of metoprolol. When I gave him his metoprolol, his HR was 64. It was a 25mg tab, so I cut it in half and showed my preceptor the other half. He coded at 630pm, I gave him a lovenox shot that morning and the 12.5mg of metoprolol and two norco around 2pm (nenver did get around to that flu shot). He also had his SCD's (pressure socks) on all day.

That day all he complained about was his hip pain and some gas. PT had him up and tried to have him weight baring at the bedside, but he was too weak. He was living independently up until this fall which is what brought him into the hospital. He was originally medical status and then switched to tele status after the triponin number. PT and INR were within normal limits.

This was the scariest day of my life. He is the nicest gentleman ever, I can't let it go in my mind. I can't help but to feel responsable, somehow. They're thinking he was having a PE, so he was placed on a heparin drip, continued on the dopamine drip, and went in to have a pacemaker put in today. He never complained of chest pain. I just don't understand how this could have happened. I feel just awful because he was MY patient and he didn't deserve to go through all of that termoile.

I'm afraid of something like this happening again. I did my preceptorship in the ICU, so I'm not a stranger to intense situations but this time it was different because he was my responsability and it came on SO quickly and out of nowhere. What if I hadn't been in the room? There are monitors at the nurses station, but many nurses get "alarm fatigue" and don't pay as much attention as they should to every little beep or alarm that goes off for the entire floor.

Thank you for letting me vent.