Patient Almost Coded

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Specializes in Transplant, homecare, hospice.

Okay...check this out...

I was called in to work extra. So I be bop in early to get report from a float nurse. He walks over to me and tells me that he left updates on the audex system and that all 4 of my patients are stable, except one who is getting blood. He said he had just hung the blood. And that was that. The problem which I will arrive to here shortly, is with day shifts reports, everyone was STABLE. No mention that one of them was bleeding out. He only left updates and didn't do a full asssessment....meanwhile...a pt is circling the drain....which I find when I get there and do my full assessments.

Okay well, my priority was to check on the lady with the blood going. I did a full assessment. She was lethargic, but easily aroused. I've taken care of her in the past and know her baseline...she didn't look so good. Pale. Her BP was slightly low but not anything out of this world. I left and did my other assessments. I went back to her room about 15 minutes later. I took a look at her, abd, she had 3 JP drains all had large amounts of blood in the bulbs. I thought the PCT didn't empty them, so I started on the first one that was the fullest....JP Drain #3. I emptied it and returned to the bedside to empty the others and #3 completely filled again with blood. I emptied it again...I did this over and over...at about 550ml in about 5 minutes, I was like...NOPE. This can't be good! I went to the PCT and asked her about it and she said that the pt drained 910ml from 7pm to 10pm. This is something the float nurse didn't tell me. So I went back into the room and saw that my pt had a change in her LOC. She had only the one unit of blood going. I called the PA immediately and she was so nonchallant saying that she knew. I said into the phone, "No, you don't understand....she's bleeding out." Then told her that she dumped out over a liter of blood in less than 10 minutes of me emptying the drain. Each time I went into the room, I or the PCT emptied that same drain over and over. I couldn't get the blood in fast enough!

We took her blood pressure, it was 71/39. Her HR 92-100 and all over the place. I went to my team leader and told her what was happening. Needless to say, the PA flew to the hospital.

It was a scary situation. I was flustered and had never seen anything like it. Within about 10 minutes of the phone call, there were 3 or 4 MD's in the room, 2 PA's, 3 nurses, a PCT...everyone was giving me orders. I felt horrible by the end of it. I got so flustered. 2L NS going in wide open, units of blood going in wide open....the MD put a subclavian central line in to get the blood to go in faster, because the PICC was too slow....it was amazing.

The pt was rushed to emergency surgery and then to the unit. She's still there and doing much better....

Does it get better the next time? I mean, when you are confronted with someone dying right there in front of you?? I was a nervous wreck!

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Yet another testimonial for walking rounds.

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That poor patient. That situation could have probably been caught much earlier if the previous nurse had been paying more attention to the patient. One really important part of this to remember is to always check your own I&O's. On my unit this is sometimes a problem b/c the PCA's empty the drains (we dont have very many b/c we are a cardiac floor) and the foleys and record it themselves. Many many times the PCA's do not report the excess drainage or lack there of. But it is vital that the nurse check this her/himself b/c of situations like the one you posted. Ultimately it is the nurses responsibility. I'm sorry you had to come on shift with your patients like this. I am one of those picky people who like to have and give a good report. It really bugs me when someone says "Oh they are all stable nothing to tell you." Especially when I have not had that patient in awhile. This is a serious job, but many people do not take it very seriously I think.

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Specializes in Utilization Management.
Okay...check this out...

I was called in to work extra. So I be bop in early to get report from a float nurse. He walks over to me and tells me that he left updates on the audex system and that all 4 of my patients are stable, except one who is getting blood. He said he had just hung the blood. And that was that. The problem which I will arrive to here shortly, is with day shifts reports, everyone was STABLE. No mention that one of them was bleeding out. He only left updates and didn't do a full asssessment....meanwhile...a pt is circling the drain....which I find when I get there and do my full assessments.

Okay well, my priority was to check on the lady with the blood going. I did a full assessment. She was lethargic, but easily aroused. I've taken care of her in the past and know her baseline...she didn't look so good. Pale. Her BP was slightly low but not anything out of this world. I left and did my other assessments. I went back to her room about 15 minutes later. I took a look at her, abd, she had 3 JP drains all had large amounts of blood in the bulbs. I thought the PCT didn't empty them, so I started on the first one that was the fullest....JP Drain #3. I emptied it and returned to the bedside to empty the others and #3 completely filled again with blood. I emptied it again...I did this over and over...at about 550ml in about 5 minutes, I was like...NOPE. This can't be good! I went to the PCT and asked her about it and she said that the pt drained 910ml from 7pm to 10pm. This is something the float nurse didn't tell me. So I went back into the room and saw that my pt had a change in her LOC. She had only the one unit of blood going. I called the PA immediately and she was so nonchallant saying that she knew. I said into the phone, "No, you don't understand....she's bleeding out." Then told her that she dumped out over a liter of blood in less than 10 minutes of me emptying the drain. Each time I went into the room, I or the PCT emptied that same drain over and over. I couldn't get the blood in fast enough!

We took her blood pressure, it was 71/39. Her HR 92-100 and all over the place. I went to my team leader and told her what was happening. Needless to say, the PA flew to the hospital.

It was a scary situation. I was flustered and had never seen anything like it. Within about 10 minutes of the phone call, there were 3 or 4 MD's in the room, 2 PA's, 3 nurses, a PCT...everyone was giving me orders. I felt horrible by the end of it. I got so flustered. 2L NS going in wide open, units of blood going in wide open....the MD put a subclavian central line in to get the blood to go in faster, because the PICC was too slow....it was amazing.

The pt was rushed to emergency surgery and then to the unit. She's still there and doing much better....

Does it get better the next time? I mean, when you are confronted with someone dying right there in front of you?? I was a nervous wreck!

HappyJax, you're awesome! The patient survived and so will you!

This is the kind of thing that happens on our unit all the time. Everything happens so fast and so furiously for an hour or two, I pretty much feel like wet spaghetti when it's over. Then I go home and I obsess over all that happened and start the prayer chain going.

It helps to hear that the patient is improving. If I hear that the patient ultimately didn't make it, I do over everything and try to determine why, so I can do better next time.

Then, it does get better. You gain more confidence in your skills and in God's design and you stop beating yourself up over imagined failings and tackle the true failings in earnest. You get better. You learn what the docs will order and you learn how to give it.

One day you're at a Code and there are some wide-eyed newbies in the room and suddenly you realize that they knew you could handle it before you did.

It's a pretty cool feeling. ;)

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Specializes in Cath Lab, OR, CPHN/SN, ER.

Good prioritizaton (spelling?) for who to see first, and good catch on realizing something not good was happening!

How scary it must have been for you, and also very frustrating. Was anything mentioned to this other nurse when they returned?

Glad the patient will be able to recover.

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Specializes in Med Surg, Hospice, Home Health.

thank GOD you got there early!!! if the other nurse would have stayed, that pt would have been dead...

GREAT SAVE!!!!!

linda

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Did the float nurse hang blood and leave?

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Specializes in tele, stepdown/PCU, med/surg.

HappyJax,

You handled this superbly. I feel honored to have you in our profession. Even someone not so in tune with what was going on might have missed this, but you didn't. Great job!

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Specializes in Med/Surg, Ortho.

Did the PCT report the amount of drainage in that JP to the nurse? Kind of makes ya wonder. Amazing if it was reported that it was ignored like that. Float or no float that nurse shouldnt be caring for patients she obviously isnt competant to care for. Big incident report filled out on this one i hope.

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Specializes in Me Surge.

sounds like you did pretty darn good. Its ok that you were nervous. You did everything that you should have done. Congratualtions on saving a life.

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Specializes in Transplant, homecare, hospice.

Good prioritizaton (spelling?) for who to see first, and good catch on realizing something not good was happening!

How scary it must have been for you, and also very frustrating. Was anything mentioned to this other nurse when they returned?

Glad the patient will be able to recover.

I sent an e-mail to my nurse manager about the incident. Curious as to what she says.

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Specializes in Transplant, homecare, hospice.

Did the float nurse hang blood and leave?

Basically. Hung it, told me he left updates (no full report) and that everyone was fine. Mentioned my one pt was getting blood, but she was fine and he left.

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