On Monday I had a rapid response and I feel so responsible for it I don't want to go back to work.
I had an elderly patient who was admitted to rule out sepsis. He came in c/o weakness and experienced chest pain the day before coming in to ED. He had hx of DM, htn, stent placement, hyperlipidemia, and early alzheimer's. When I recieved him in the morning his BP was in the 150s and all his vitals were WNL. He was a/o x4 but the night shift nurse during report said for him he was a/o x1 which could have been due to language barrier.
In the morning his sugar was 175 he was due for 20units of lantus, 5 units fixed humelog and 1 unit of sliding scale. I saw him eat his breakfast which was 1 pancake and some fruits. After i gave his 9am meds he seemed fine. Around 11 when i took his vitals it was 110 systolic and everything else seemed to be ok except he was sleeping and seemed a bit short of breath but he was saturating 96 in RA. I asked my preceptor if giving him oxygen would help she said yes lets give him some O2. I gave him 1L of 02 with humidifier to see if it would help and he reported he was breathing better. I rechecked on him 30 min later and again he seemed SOB and still he was saturating at 97 i increased his O2 to 2 units for comfort and he was sleepy at this time but when i woke him and asked him how he feels he said fine.
Anyway at 12:30 he was due for 5 units of fixed humelog and 1 unit of sliding scale his fs was 190. I for some reason thought he had eaten his lunch and gave him his insulin. He had refused to eat his lunch. I should have held the insulin but didn't. When I continued to check on him after the insulin administration he seemed sleepy and was jittery and thought maybe he was having anxiety. When my preceptor took him down at 4pm for stress test she noticed he didnt look good so she brought him back up and then reported the charge nurse and unit manager which then they came in and he was lethargic and hard to awake. His fs showed 35 and his bp was in the 80s. 1/2 Dextrose was pushed IV which his blood sugar went up again but began to drop back down so the rest was given. Rapid response was called and he ended up getting transferred to the ICU. Last finger stick was 186.
during the rapid response when my charge nurse called his dr the dr said last time the pt came in he ended up at the ICU and he was suspecting the pt was taking something that he was withdrawing from.
Now idk what the deal is here and I can't stop blaming myself and want to quit. I wish i had made sure he had his food before giving the 2nd dose of insulin. I feel so incompetent and terrified.