I want to know if anyone can help me handle this situation. I work in a small 3 bed ICU where I am the ONLY nurse. I recently had two critically ill patients. One had been on the floor (I had worked there one night and had her) and been transfered to the ICU with CP and ekg changes prior to my arrival that night. The cardiologist said the changes were not new, nor indicative of an MI.Her orginal DX was Vomiting and diarrhea. Upon arrival to the unit, I noted the patien's LOC was decreased and told it was because she had been given ativan for confusion and aggitation. I noted her adbomen was large, distended and hard, she was tachycardic and her BP was much lower than her baseline (noramally hypertensive.) I called the Md and reported these findings. Her H&H was WNL, but she was pale, grey and cool. I requested an NGT, but was told to "continue to give dulcolax as she had an ilieus and he wanted to get her bowels moving." The patient continued to deterioate and I called him to inform him there was no UOP over the past hour. He ordered lasix. I ended calling him at least 6 times as it was fairly obvious I had a GI bleed on my hands and I needed orders to take care of this patient. I kept the shift supervisor informed, but they were short on the floor and he had patients and told me I would just have to keep calling the Doctor. IV access was lost 4 people attempted to restart to no avail, Lab was unable to get blood from anywhere, including fingersticks, and I needed a central line and could not get anyone to come in and place one. And her left hand turned purple and pulseless over the course of the shift, a fact I reported everytime I called. The next night, I was told by the shift supervisor that this doctor was oncall again and had said I was not to call him that night for any reason as I had kept him up all night and he was sleep deprived. He said I was to write orders for anything I pleased and he would sign them in the morning! I got in trouble the next day because the patient's BP dropped into the 40's and I called HIM at 2300! I can't believe this. The is no protocol in place that would have allowed me to write an order for Dopamine and this patient was a full code.
