Thank yall for your posts. I am a recent grad (May), I have been off orientation 4 days and I am working at a level one trauma center in the Surgery Trauma Intensive Care Unit. I have actively participated in 2 codes. One during my practicum as a student and this one last night. I was the primary nurse and I have to admit that I was terrified...
Since I am a new grad the charge nurse assigned me one of the lower acuity patients... He had a C5-C6 fracture and had been in our unit less than 2 weeks. He was having problems with autonomic dysreflexia (as he was a quad) He had a trach placed Thursday am *so roughly 72 hours prior*
I am the new kid on the block but I can smell a GI bleed from a mile away. His coags and H/H were slightly abnormal. He had dark brown thin residuals from his PEG and the insertion site was weeping serosanginous fluid (a substantial amount) His a-line and TLC were also seeping serosanginous fluid. I made the comment that I thought he may be going into DIC during shift report. His O2 sats were hanging on the low side 91% so I notified respiratory and I suctioned my patient. What I got back was frank blood.
Doc bronched him for a while and his sats steadily dropped. We ordered a stat CXR and it revealed a small pneumo and the doc elected not to place a chest tube right then. Well over the next 30 minutes He was on a peep 22 and 100% FiO2 and his sats were in the 70s. Called the doctor back and he put a chest tube in. Immediately his sats came back up to 100% he was pink, following commands, and just totally with it.
He was a night bath and he was filthy. I spoke to the charge nurse and we felt that he was stable enough to turn. There were NO do not turn orders on the patient.
His T&L were clear but just to be safe I had two other nurses at the bedside to log roll. Sats were BEAUTIFUL when he was on his right side (toward the vent) but when we rocked him slightly to the left to pull the sheets out from underneath him his sats fell from 100% to 88... then to 70.
Doc back at the bedside, rebronched. He saw a massive clot that was blocking the right mainstem. He continued to manipulate the clot without much success. Sats down to 27. Then 18 then pulseless.
Code 1. Chest compressions, bag, Responded to Epi-Atropine-Epi. Epi gtt started Dopamine stared. SVT 160s
Sats 50s Rebronched sats 70s... then fell. Then SBP the HR.
Code 1*2 Epi push, Atropine, Amio- responded. Family called. On there way (staying 2 hours from the hospital)
Rebronch with the attending at bedside. The attending said that the clot was well organized and looked like it had taken days to develop... he assumed that it was a result of of the trach site blood slowly trickling down... (terrible)
Code 1*3 Started at 0617 same as before... ribs cracked during compressions ended at 0645 when the patients family arrived and opted to withdraw care. Gtts and vent off. Asystole in 5 minutes
Now... I feel guilty. I feel confused. Angry at myself. Incompetent. During the codes I was shaking, the charge nurse pushed the drugs. I monitored the vitals and gtts. Could I have done more? Is this my fault? When I saw the family a couple tears slipped down my cheek.
The first thing that his wife said to me was "I am so thankful that you were his nurse. I know that he was well taken care of. He always looked so clean when you had him" (This was only my second night with the patient) She said that she knew that we had done everything that we could. And that she woke up around 0300 to him (my patient) approaching her in a dream to tell her that he was "going home." She also told me that she felt he had waited to pass until his daughter that lived out of town could get there. (She came for the weekend).
I believe in God and Heaven and a life that is better beyond this earth. But I also believe in medicene and the science behind health care. I am just sad and bummed that my patient died.. =(