Please NEED HELP - nursing student

[DatMurse]

I was in trauma icu today. the patient was compliant and the nurse allowed him to write on a paper to talk to his family. he had an ET tube on. he wrote fine and didnt do anything over 2 hours. As the family left I was going to restrain his left arm and he tried writing to me saying suck. I grabbed the sunction and he started to vomit. He then grabbed the ET tube and pulled it straight out and I yelled for help.

The nearest nurse came over raised the head of the bed. He just had a spinal fusion and the charge nurse ran in saying "dont raise the head of the bed it can cause paralysis". I told him I didnt do it.

The patient started talking and breathed on his own but I am still shaken up. I know it wasnt my fault cause I just listened to my preceptor and it is just the fact I was part of all this.

The charge nurse knew it wasnt my fault but he said he never had a patient become extubated

Has anyone experienced something like this:?

[alrighThen]

It was probably very nerve wracking to watch as a student. But it happens. I'm sure the patient panicked as he began vomiting and of course it is was a reflex to try and remove the foreign object (ETT) from his airway. That's what the restraints are for. Good job yelling for help right away. I once had a patient break through his restraints and extubate himself as I was standing at the bedside. I tried to stop him but he was stronger than I. Happens.

[Keep_Calm]

Chalk it up to experience! That's what clinicals are for. It sounds like the situation could have been a lot worse. Be thankful for the experience and thankful it turned out ok.

[netglow, ASN, RN]

:hug: Now you really know. That's ICU. It's 0 to 1000 in a second. Lots of very focused intense faces and to the point talking and running. I did a preceptorship or what some call a capstone in ICU as well and it's a good thing you see and feel this. Lots of people are hell bent on ICU, but never get to see what kind of person you have to be to survive there. Wild stuff.

Pat, pat, pat (me patting you on the head) now get yourself some junk food and watch some TV and go to bed. For tomorrow IS another day!!!!!

[classicdame, MSN, EdD]

You learned an important lesson - expect the unexpected. You never have full control, but you just plan as if you do

[Double-Helix, BSN, RN]

I think being intubated and alert must be one of the most terrible feelings. I know that even when I have something caught in my throat it makes it very difficult to relax or focus on anything else. An ET tube is like having a big plastic stick stuck in your throat. When the patient was vomiting, he wanted to breathe deeply and cough. The ETT was preventing that, and his natural reaction was to pull it out. There's really nothing you could have done. And good for you for interpreting the written word "suck" as the patient needing to be suctioned! I'm not sure I would have caught on that quickly.

Why was the patient still intubated if he was able to talk and breathe on his own? Did he end up re-intubated? I work with pediatrics, where we keep our kiddos sedated unless we are approaching extubation, so I don't have experience with intubated adults and the criteria for extubation.

As an aside, if you've released the restraints for two hours while the patient was calm and talking with his family, you can't just re-apply the restraints when they leave. You need to obtain a new order for restraints.

[DatMurse]

I think being intubated and alert must be one of the most terrible feelings. I know that even when I have something caught in my throat it makes it very difficult to relax or focus on anything else. An ET tube is like having a big plastic stick stuck in your throat. When the patient was vomiting, he wanted to breathe deeply and cough. The ETT was preventing that, and his natural reaction was to pull it out. There's really nothing you could have done. And good for you for interpreting the written word "suck" as the patient needing to be suctioned! I'm not sure I would have caught on that quickly.

Why was the patient still intubated if he was able to talk and breathe on his own? Did he end up re-intubated? I work with pediatrics, where we keep our kiddos sedated unless we are approaching extubation, so I don't have experience with intubated adults and the criteria for extubation.

As an aside, if you've released the restraints for two hours while the patient was calm and talking with his family, you can't just re-apply the restraints when they leave. You need to obtain a new order for restraints.

car wreck ejection that same morning. He came in sedated and he had to get an emergency lumbar spinal fusion. he was able to talk on his own and he is doing fine. the restraint was coming on and off for 2 hours and wasnt left off for the entire period of time. The nurses in the ICU helped me feel better and pretty much said **** happens and just make sure you learn from it.

he is doing fine. I was stressing the importance of the incentive spirometer and it was even more important because he pulled out the ETT.

L3 fracture, right sided pulmonary contusion followed with the right lower lobe atelactasis, laceration across his right eyelid and a fracture on his right part of his mandible

[twinmommy+2, ADN, BSN, MSN]

I don't have much to add but sounds like you had a killer awesome clinical day, one alot of nursing students would love to have.

[HouTx, BSN, MSN, EdD]

I know it is not going to make you feel any better, but self-extubation is a common event in ICU. Patients have told me that they 'had' to do it because the experience was so horrible. That's why patients on ventilators are normally sedated. If they are not sedated, it's usually because they in the weaning process. Non-sedated vent patients should always be considered 'at risk' of self extubation. In most cases, the worst thing that will happen is trauma due to ET balloon still inflated or sudden aspiration of oral secretions.

It's important to handle this in the same way as other 'unexpected events' - e.g., incident report. But usually, the outcome is not really horrible - not like accidentally pulling out a SWAN because the tubing was tangled on your stethoscope. . . ah, but that's another story entirely.

[DatMurse]

There is a rumor now in the Trauma ICU from a female nurse... stating I wanted the patient to self extubate and was the reason he did. They told some other classmates and I am a little shocked someone would say that. The charge nurse and the other male nurses knew I was extremely distraught that it happened. I honestly find it very shocking someone would even say that I wanted it to happen. I am not sure of what I should do in regards to it... I just heard of this thing being said to some other classmates 2 days ago...

[NurseOnAMotorcycle, ASN, RN]

Well that's just stupid. If anyone asks, just say so.

[Tait, MSN, RN]

There is a rumor now in the Trauma ICU from a female nurse... stating I wanted the patient to self extubate and was the reason he did. They told some other classmates and I am a little shocked someone would say that. The charge nurse and the other male nurses knew I was extremely distraught that it happened. I honestly find it very shocking someone would even say that I wanted it to happen. I am not sure of what I should do in regards to it... I just heard of this thing being said to some other classmates 2 days ago...

Rumors are just that, rumors. Don't worry about it :)