Rough Night...

[zambezi, BSN, RN]

Working in critical care, one would think that I we have more patients pass on...but in reality, I really don't get that many. I got report from the day shift on a patient that had been admitted four hours prior...she had gotten report from the transfer hospital that in no way matched the patient. She said she was expecting a fairly stable patient...patient wasn't even sent acls transport...patient was close to unresponsive upon arrival with a pH of 7.1...intubated patient...patient was a fairly fresh dcd post op from a couple of days ago... etc...When I took over, patient was responsive, vented, max dopa, and epi started. BP remained low...BP were acting strange, very narrow pulse pressures...neck very swollen/purple/draining (culture not good) from previous surgery...Checked temp up to 40.5. Called doc. Intervention done-cooling blanket/tylenol/fan/etc. Checked temp again in one hour temp 41.5. Starting to have bad feeling at this point...BP low, HR dropping, dopa, epi, vasopressin started (would have loved a swan to see what I am sure was a nonexistant SVR) HR initially afib 100s...now 80...needless to say, bad feeling continued. Resp. Rate now up to 30s..pt had no sedation on board so I gave just .5 mg ativan, patient appeared more relaxed/RR still 20-30. Went out of room to check on something and came back in pt unresponsive..pupils fixed/dilated...pulse palpable but not great/HR remained 70-80s...code cart in because I could see it coming...called doc while another watched the patient...told him of bad feeling/unresponsiveness, new cyanosis, questionable pulse...Hung up-pt asystole...aaahhhh! Got her back, but never responsive..lots of epi/max dopamine/vasopression at max...not a good BP (im pretty sure that she was going in and out of pea...think she had a recent heart attack too...) Anyway, I think she died close to that point though monitor still had rhythm and pulse was difficult to palpate... ABG showed metabolic acidosis pH 6.9...Doc talked to family changed to no code...I called time of death approxiamtely 3 hours after code after watching hr dwindle down all night (Personally I think PEA for last hour or so because she was sooooo mottled.) Family was able to be with her for those 3 hours. Even though I saw this coming it is still a bummer when the patient dies...It always hurts to see the family hurting...

[zambezi, BSN, RN]

oops!!!posted this in the wrong discussion!!! how do you change forums once it is posted???

[jnette, ASN, EMT-I]

(((((((((((HUGS))))))))))))) Zambezi...

please take a nice warm and relaxing bath, and be as good to yourself as you were to your patient. So very sorry for what must have been a grueling night for all involved.