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New Nurse's 1st Crash & Burn

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by JazzyK89 JazzyK89 (New) New

This is my first time posting a thread-had an absolute train wreck last night and it was my first time I had to call a code. I'm a newly licensed RN (working less than a year) and had my worst case to date so far-pt. was transferred to our unit in septic shock. She had previously came from the NSICU as a rule out CVA. Pt. with history of R. Pneumonectomy and DM type 2. Her CT scan showed humongous L. sided pneumonia, so oxygenation was an issue ovn, and the respiratory therapists were working endlessly last night to o ygenate her the best we could. When I got the pt, she had only recieved about 4 bluid boluses in ED so we started bolusing on pressure bags, Arterial line was placed and another central line was inserted ( she already had a r. groin TLC). Pt. was already maxed out on Dopamine and Levo when I got her and blood pressures were terrible, like 80s/40s-50s and MAP

Sorry it cut me off. MAP

Cessna172

Specializes in ICU & LTAC as RN. FNP. Has 12 years experience.

wow, what a wreck that patient was. I'm glad I don't do that any longer. There was nothng left to offer in terms of meds, good job!

HouTx, BSN, MSN, EdD

Specializes in Critical Care, Education. Has 35 years experience.

So sorry you had such a bad experience. I know it won't make you feel any better, but successful resuscitation of advanced sepsis/septic shock is rarely successful. That's why there is such a HUGE emphasis on understanding & integrating MEWS scale ratings into all areas of patient care in the US these days. Mortality increases dramatically for each hour that sepsis goes undetected, no matter what setting the treatment occurs.

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

first i have to say.......you've come a long way baby!!!!!!!! :smokin:

wow.....new nurse, newly licensed, who is working in what is clearly a high level icu. what a night :hug: . you must have had one heck of an orientation and are one smart, calm cookie.....for that was one very sick patient. sepsis, septic shock/sirs can be one of the deadliest things to patients and difficult for nurses because we are busting our butts off and they slip through our fingers. :sniff:

to me, you gave this patient the best fighting chance to survive a terrible illness and it was a job well done. :yeah: in icu when the patients are so very sick and you have one that circles the drain, as this patient did, you need all the help you can get. it is always a team effort in a good icu when there is a critical patient as complicated as this one. you did an excellent job! and you should be proud.

bobbyzr7 said it reminded him that he is glad he doesn't do that any longer.......it is a personal choice and that is the beauty of nursing that you get to try something new and find your niche. me, on the other hand, who loved the sickest of the sick.........makes me wish i could work again...i miss it so. :sniff:

they only med you didn't mention, so i don't know if you gave it, would be the anti-histamine, histamine blocker and steroid combo for the sirs (systemic inflammatory response syndrome). other than that.......you did it all.

i am sorry that the patinet did not have a good outcome and i am sorry to the patients family, my heart and prayers go out to them.......

but from a crusty old bat iccu nurse.........job well done!!!! cheers :cheers:

Thanks everyone for your responses:) And to address the antihistamine, histamine blocker, steroid combo-she did get a dose of solu-medrol, but that was it. I did feel terrible for the family because they were having difficulty comprehending how sick she really was considering she had been admitted to the hospital the same night all of this happened...just very sad all around. But Esme, thank you so much for your kind, thoughtful words-I definitely appreciate it! It was a whirlwind shift, and as much as I hate to see pt's that sick, I was running on pure adrenaline by 7am that morning and it did feel good to know that I am capable of taking care of these patients:)

DebanamRN, MSN, RN

Specializes in Hospice, ER. Has 10 years experience.

You did a great job. Lots of times the family doesn't understand, or won't understand, or won't accept, or can't accept, how sick the pt really is. Everybody hopes for a miracle, but sometimes it just doesn't happen. When its time to go, its time to go - we can only beat back the grim reaper so long, but he eventually gets through our blockade and snags the pt. All you can do is offer kind, gentle, and sympathetic words and make the pt look nice for the visitation. We deal with this in the ED all the time but it is never easy. And to agree with HouTx, sepsis screening is so essential. We now have a screening tool in our triage screen which is great. I recently had a pt come in for r/o cva but I thought he was septic. Sure enough, he failed his sepsis screen, and was admitted for urosepsis. But sometimes its just too late. Again, cheers, you did the best job possible.:thankya:

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

Thanks everyone for your responses:) And to address the antihistamine, histamine blocker, steroid combo-she did get a dose of solu-medrol, but that was it. I did feel terrible for the family because they were having difficulty comprehending how sick she really was considering she had been admitted to the hospital the same night all of this happened...just very sad all around. But Esme, thank you so much for your kind, thoughtful words-I definitely appreciate it! It was a whirlwind shift, and as much as I hate to see pt's that sick, I was running on pure adrenaline by 7am that morning and it did feel good to know that I am capable of taking care of these patients:)

Welcome to the addictive world of ICU.....:bugeyes:

Merlyn

Specializes in none.

This is my first time posting a thread-had an absolute train wreck last night and it was my first time I had to call a code. I'm a newly licensed RN (working less than a year) and had my worst case to date so far-pt. was transferred to our unit in septic shock. She had previously came from the NSICU as a rule out CVA. Pt. with history of R. Pneumonectomy and DM type 2. Her CT scan showed humongous L. sided pneumonia, so oxygenation was an issue ovn, and the respiratory therapists were working endlessly last night to o ygenate her the best we could. When I got the pt, she had only recieved about 4 bluid boluses in ED so we started bolusing on pressure bags, Arterial line was placed and another central line was inserted ( she already had a r. groin TLC). Pt. was already maxed out on Dopamine and Levo when I got her and blood pressures were terrible, like 80s/40s-50s and MAP

Welcome to the Wild, Wonderful, World of Nursing! Nights like the one you describe have and are happening to all nurses every day. I guess they didn't tell you that in Nursing School, that you would be admitted to the head banger's union. The good news is it will get better the longer you are in nursing the bad news is that you will have more of the shifts you spoke of above. Have a drink and welcome.

don't apologize for needing help on this trainwreck-- i don't know any hotshot icu nurse (including me, years ago) who wouldn't need help on all this. sometimes you need three or even four nurses assigned to a patient, and this is the kind of patient that warrants it. i used to love patients like this, but it is better to have a few of them make it, or it gets really depressing. some of them do make it, so do not despair. you did a great job-- we can tell by the way you tell the story that you have learned a lot already.:yelclap:

yep, sepsis can kill very fast-- a little faster than a few episodes of house. just had an elderly relative die of this-- she had had a picc in for home antibiotics for an infected finger (!) and the vna found her a little loopier than usual when they went one afternoon to give her vanco. admitted by 9pm, dead by 6am. fast has some advantages. i don't think she ever knew what hit her.

gonzo1, ASN, RN

Specializes in ED, ICU, PSYCH, PP, CEN. Has 18 years experience.

I did ER for 7 years and transferred to the ICU last October. So you can see I haven't been an ICU nurse for long. You did a great job with your pt. Sounds like the nurses you work with really appreciated the great job you did. From what you describe I wouldn't even want this pt. I don't think I've had one that bad yet.

I thought all my ER years would help, and they do, but in the ER you are "reactive" to everything, in the "ICU" you learn to be "proactive". I have had a couple crashing pts that I was worried about how I did.

So give yourself a pat on the back, say a prayer for your patient and keep on trucking. The learning and growing never ends. I am lucky enough to work in a supportive environment that really values education. I hope you have the same. By the way, it is okay to feel bad about your pt not making it. Maybe even a small tear or two after the job is done. When you don't care anymore it is time to hang it up.

funnyliz

Specializes in CCU/ER. Has 11 years experience.

Great work !!! This coming from an ER nurse who quickly (often with smoking' wheels) runs her patients up to you for the 1:1 care that they need. Coming to ER from CCU, I can relate to your night shift and to the realization that the family just isn't anywhere near where the patient is ~ :uhoh21: I think you did a wonderful job recognizing what was happening and running all your meds and doing your best !! Nicely done! and to second the motion by Esme12 -- have one stiff drink:cheers: and let it go - you did your best !!! (*There is a reason they are in an ICU - these folks are already circling the drain)

Chiggysmom

Specializes in Oncology. Has 13 years experience.

I'm an oncology nurse and don't do what you do. When our patients go bad they're rapid responsed and shipped out to more appropriate setting. I'm very impressed with your performance. Great job!

RealNurse419

Specializes in Intensive Care (SICU, NICU, CICU, VICU). Has 6 years experience.

Sounds like you did an excellent job! Septic shock patients are hard to get back once they get really sick like this patients seemed to be. You did a wonderful job!! I would have maybe added some albumin or hespan to drive the fluid in. Septic patients are very verrrry volume depleted, so that could have helped pull the fluid into the intravascular space.

Wishinonastar, BSN

Has 36 years experience.

How sad. It is always so hard for the family when it is fast like this. Sepsis is sneaky, especially in the elderly. The poor family is probably feeling so guilty.

It sounds like you have a supportive team there. You are very lucky. From what I have seen, though I have been out of acute care for a while, it seems that the critical care areas do support each other better and pull together in a code. You are doing well to be so new and be functioning in such an area. I never would have dreamed of doing that as a new nurse, though ICU was my favorite clinical experience.

It makes me feel good to know that there are caring nurses like you still going into nursing. I was beginning to lose hope. I have had some experiences in recent years with my parents in hospitals that were not very positive. You gave your all. It was not meant to be.

I am a new ER nurse with 10 months experience, working in an ER that gets a high volume of SNF patients. I was handed-off a hypotensive patient by the night shift RN. At the end of her report she says, "Good luck with this one." Needless to say, I ended up giving this lady 4 liter boluses, maxed out her levophed (she couldn't get dopamine - she was tachy in the 140's-160's), gave her albumin 2x, neosynephrine, solu-medrol, etc. etc. Her family was at the bedside the whole time. I felt extremely frustrated and defeated as her SBP stayed in the 60's. Her WBC count was in the 40's, lactic acid was upwards of 9, K+ level was 7+, her kidneys were shot. She coded later that day after I transferred her to the ICU. I felt awful knowing she didn't make it. My old preceptor pulled me aside and told me that the patient was tired and her body couldn't keep up with her organs shutting down. She told me I should be proud to know that I did everything I can for that patient. Since then, I make it a point to reflect on my day and realize that regardless of what the outcome was, if I saved lives or lost some, if I am able to say that I did right by my patients, it was a good shift.

ckh23, BSN, RN

Specializes in ER/ICU/STICU. Has 6 years experience.

Strong work. You'll never forget this experience and you'll be a better nurse for it. As others mentioned, sepsis can kill quick and despite our best efforts the patient eventually dies.

I fail to see the "crash and burn" part .... Good Job!!