Question about post code pt.

[Sugarcoma, RN]

I am a floor nurse and when pt.s code etc on our floor they are whisked off to SI or MI and we don't always get a lot of answers or get to see their progression. Anyhoo here is my question, When a pt. codes would that cause an almost two-fold increase in WBC's? Pts. WBC pre code was 18.6, post code (3 hrs later) 46.3??? is this just from tissue destruction and inflammation or does this point to a serious sepsis going on? Forgive my ignorance but I am really curious and my lab book just says increases can be due to tissue destruction and inflammation but doesn't give any type of specifics.

I have never gotten to see a pts. labs post code. I expected them to look bad and they did but did not understand the huge increase in WBC's.

[WalkieTalkie, RN]

Septic shock would be my guess, with impending MODS.

Here's an article: Multisystem Organ Failure of Sepsis: eMedicine Critical Care

[Zookeeper3]

Septic shock would be my guess, with impending MODS.

Here's an article: Multisystem Organ Failure of Sepsis: eMedicine Critical Care

THis was my guess too, sometimes sepsis is looming, lurking then BAM, it demands your attention. THe WBC's of 18 was the clincher. The stress response of the code does not double the WBC's. Great question! THese guys are sick, sick. Sometimes the earliest warning signs are decreased loc or confusion. An abg usually shows a very low pH.

Do I hear a future ICU nurse?? You never know... just keep your options open:D

[Sugarcoma, RN]

That article was very informative, thank you for the link! And Zookeeper you are right ABG's showed ph of 7.19

You know nothing ever presents itself the way you learned in school and it drives me nuts when I don't understand something. My coworkers and most of the residents eyes glaze over when I start asking questions! lol. I just started on an EKG book to improve my tele skills and the ICU book just to get some more in depth knowledge of physiology. Luckily I have allnurses to utilize when I do not understand something! You guys rock!!

I would love to move into the ICU. SI in particular. I hate being on the floor and having 7 or 8 of these patients and not being able to give them the time and attention they need. With more astute monitoring we could prevent a lot of complications these people have, but most nights we are lucky to just sling pills and chart!

[CNL2B]

This may be indeed be a sepsis situation. I have seen it, however (and had docs explain it to me as well) that some of the interventions that we do intra-code and post-code may cause a stress response and elevate the WBCs some, but not to that degree. I've had it blamed on line placement and intubation, but usually that is something like a count going from 12 to 18, etc. WBCs in the 40s is most definitely pathological.

[tri-rn]

My coworkers and most of the residents eyes glaze over when I start asking questions! lol.

Sugarcoma, this made me chuckle because I have this experience all the time OR, a resident will give me some super-simplistic explanation that I either already knew or could have figured outl, when I'm looking for a deeper answer. We have a few nurses who are like me (like to understand things) and will explain in-depth, and I've learned to look things up at home a lot :)