"The Turn"

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I'm just wondering if anyone knows they physiology behind the "fatal turn" It's commonly heard that often times when someone is actively dying and you turn them, they often die soon after. I recently saw it for myself the other day. I had a pt where the family withdrew life support so we had the pt on supplemental oxygen and a Morphine gtt. He maintained stable vitals for about 3 1/2 hours after extubation. Then I finally decided to turn him and get him cleaned up (he had a lg BM) As soon as I was done his pulse started droppping and he lost palpable pulses and his BP. Within 15 min he was gone. Anyone know the physiological sequence of events that causes this???

Specializes in Postpartum.

I'm not sure why, but I know that when we have an otherwise healthy pt (postpartum) who has a slightly elevated bp we tell them to lay on their left side and take it again 5 min later. Sure enough the bp drops a bit. I would love to know why, but can't find anything on it.

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Specializes in Med Surg, Hospice.

I have one patient in hospice now and every time the nurse and I go in to clean her up, we stay in the room longer than necessary to see if she is still breathing.

We were taught in NA class that turning sometimes becomes the precipitating event to death, but it wasn't explained why. The teacher took a lot of questions about it and she insisted it was nothing that you did personally. Still, it makes you feel like you did bring it on and the "If I wouldn't have turned them, they wouldn't have died" thoughts take over.

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Specializes in Rehab, Med Surg, Home Care.

Wow. Had this happen to me while working with another nurse with CC experience. She helped me turn/ reposition my dying pt; he was gone about half an hour later. She said she was thinking "Hmm. I don't know if we should be doing this...". I thought it was just anecdotal.

Had another one shortly thereafter. A "Comfort Measures Only" pt moved to our MS at change of shift from one of the "units" b/c they needed his CC bed for someone who could benefit from it. Accompanied by a number of family members, this poor guy went on a long, bumpy ride to our floor where his care was given over to really, a bunch of strangers. He was minimally conscious but the family was quite distressed to lose the caregivers they had come to know and trust during the weeks of his illness and the transferring nurse was very saddened to have to give up his care at this point. We barely got him settled in; he was gone within an hour.

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my theory is that turning the patient causes an increase in intra abdominal pressure. this stimulates the vagus nerve, which in turn slows the heart rate and lowers the BP.

b/c the patient is already severely compromised (in the process of dying) - this 'pushes them over the edge'.

only a theory.

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My only experience with this was an older lady complaining of chest pain. She was in the back bedroom (I was a Paramedic), we put her on our bed, rolled to the door, and had to put it in the sitting position to get around the corner -->CARDIAC ARREST right now.

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Thanks for all of your replies, I'm going to try to find an article explaining the physiolgy and if I find one I'll post it for everyone!

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Specializes in LTC.
Thanks for all of your replies, I'm going to try to find an article explaining the physiolgy and if I find one I'll post it for everyone!

Thanks for keeping us posted...this is really interesting!

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Specializes in Telemetry, CCU.
I'm not sure why, but I know that when we have an otherwise healthy pt (postpartum) who has a slightly elevated bp we tell them to lay on their left side and take it again 5 min later. Sure enough the bp drops a bit. I would love to know why, but can't find anything on it.

I'm thinking because left side-lying is the position to increase placental perfusion, so if you are increasing blood flow to the placenta, you will lose some peripheral circulation, therefore, decreasing the BP. Even though the placenta is gone by the postpartum period, maybe the blood still wants to go to the uterine area.

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Specializes in Utilization Management.

I've noticed that also. I always thought that the stimulation to the skin and periphery caused the blood to perfuse more to those areas, affecting the supply to the organs.

When working with the dying, I learned to have all the linens ready and move the patient as little and as gently as possible. Start the bed change with the patient in his original position, try not to completely lower the HOB, wash only what needs washing (face, peri), and move the patient very minimally. Repositioning in small increments also seemed to work, for instance, from partial sidelying --> full sidelying --> partial sidelying --> back --> other side, partial sidelying --> full sidelying. No big changes like HOB way up or down, only small incremental ones.

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Specializes in Med-Surg, ED.

I have seen this too, and wondered. I have always kind of thought it was just that the nervous system can't compensate...raise/lower the bp, raise/lower the pulse...and the person who is dying is just overcome. Ive also wondered if it has to do with acidosis or alkalosis and the breathing patterns of the dying...I am not the best at the physiology so I haven't really explored but in general ideas.

I know that I don't like moving and repositioning dying patients because I just know it hastens things.

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who says nurses don't critically think! :bugeyes:

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