New Nurse's 1st Crash & Burn

Specialties MICU

Published

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

Specializes in Oncology.

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!

Specializes in Intensive Care (SICU, NICU, CICU, VICU).

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.

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.

Specializes in ER/ICU/STICU.

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!!

Specializes in ER, progressive care.

Septic shock has a mortality rate of 25%-50%, so once patients go into septic shock it is very hard to get them out of it. I think you did a great job, OP! You did everything you could have possibly done and it's good to know that it seems like you have some great coworkers to help you out, as well! :redbeathe

Specializes in Neurosciences, cardiac, critical care.
Septic shock has a mortality rate of 25%-50%, so once patients go into septic shock it is very hard to get them out of it. I think you did a great job, OP! You did everything you could have possibly done and it's good to know that it seems like you have some great coworkers to help you out, as well! :redbeathe

The numbers I've read are much higher- >50%, and up to 90% with late stages of septic shock, which it sounds like this patient would definitely qualify for!!

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.

Great suggestion, as long as the pt isn't in SIRS. If the cap membrane is still too permeable (which it most likely is as bad as this pt sounds) then albumin shouldn't be given b/c it'll just leak out into the tissues, pulling fluid with it and making the relative hypovolemia even worse.

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