This recently took place in front of me, (not in my care) and involved a charge RN. It has really bothered me and I wanted to see what you all thought.
Male, 57, suspected MI day before. Had vomited some dark emesis previous day. You walk in and his sats are 77% on room air. You place 2L o2 by nc and pt doesn't tolerate, so you change him to a non rebreather at 15L o2. Ok so far, pt states "I just want to stop breathing". Blood pressure is 58/0, Abgs are obtained and the tube is very dark, almost black. ABG comes back ph 7.2, lactic acid 8 (granted not a good number to start with). The Rn of this pt has called md and order for IMCU bed obtained. I walked in and the pt is turning blue in the face, and I inquire about called a CAT call (our rapid response team, I am thinking intubation as blue is not a good sign.) Charge RN says "We already have an Imcu bed and we have everyone we would need here. Lets get going". The charge Rn, new grad Rn and Precepting Rn and respiratory tech are at the bedside. They grap the respiratory box off of crash cart and go to imcu. (I am thinking I want a better airway than this and how about some drips to address the BP).
The end of story is patient was placed in imcu and after 20 minutes transferred to icu and intubated. By this time he has a bp of 48/0 and ph 6.8 lacitic acid of 12. (this was over 1 1/2 hours. From floor to icu) Pt ended up not making it. I am disgusted that the Charge RN was told by the Manager that nothing else could be done, she did a good job. I am thinking she should have got more help, so that drips could have been started earlier and maybe have given him a chance. I feel for this patient and family. Do you think I am being too critical here or is there room for improvement. I have been doing this for over 6 years, would like to think I can see trouble. Turns out pt never had an MI, miscommunication between shift RN's!