Smetimes I wonder why I try! (long)

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Specializes in SICU, CCU, MCU, peds, physician's office.

The patient has not seen a doctor in over 20 years and has not left the house in 6 years. She was admitted last Thursday with Afib with RVR (rate 180). She was later found to be septic, in shock, have an ef of 35%, and shocky liver along with hepatic failure due to taking Tylenol 6-8 times per day per family. She also weighs 300+ pounds. The patient coded early Sunday AM and was put on Vasopressin and Dopamine (no titration orders, set rate only) and intubated and put on the ventilator.

Today the patient's BP began to drop from a baseline in the 90s-110s systolic to 80s then 70s. I placed calls to both the pulmonolgist and cardiologist and told the office that I needed to speak to them ASAP. I could not get a return call, so I started increasing the pressors I had going. 30 minutes later I finally get in touch with someone from the cardiology office (the PA) and tell her of the situation. She comes to the ICU to see the patient and by that time the BP is in the 60s but the patient still has a good pulse and sat. While the PA is assessing the patient, the patient loses a pulse and we her yet again! The pulmonologist and cardiologist both show up to the code and want to know WHY I WAITED SO LONG TO CALL THEM!!! and who said I could touch the drips. My charge nurse assured me that she would have done the exact same thing and that I did the best I could with what I had to work with, but still it is VERY ANNOYING!!

I just had to get that off of my chest. I feel much better now!

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if you are working in critical care isnt it your nursing judgement that gives youthe right to titrate the drips if need be.

well i would have tried to help the pressors with titrating the drips also.

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Specializes in Cardiac, Med-Surg, ICU.
The patient has not seen a doctor in over 20 years and has not left the house in 6 years. She was admitted last Thursday with Afib with RVR (rate 180). She was later found to be septic, in shock, have an ef of 35%, and shocky liver along with hepatic failure due to taking Tylenol 6-8 times per day per family. She also weighs 300+ pounds. The patient coded early Sunday AM and was put on Vasopressin and Dopamine (no titration orders, set rate only) and intubated and put on the ventilator.

Today the patient's BP began to drop from a baseline in the 90s-110s systolic to 80s then 70s. I placed calls to both the pulmonolgist and cardiologist and told the office that I needed to speak to them ASAP. I could not get a return call, so I started increasing the pressors I had going. 30 minutes later I finally get in touch with someone from the cardiology office (the PA) and tell her of the situation. She comes to the ICU to see the patient and by that time the BP is in the 60s but the patient still has a good pulse and sat. While the PA is assessing the patient, the patient loses a pulse and we her yet again! The pulmonologist and cardiologist both show up to the code and want to know WHY I WAITED SO LONG TO CALL THEM!!! and who said I could touch the drips. My charge nurse assured me that she would have done the exact same thing and that I did the best I could with what I had to work with, but still it is VERY ANNOYING!!

I just had to get that off of my chest. I feel much better now!

Well gee, what else were you supposed to do? You didn't specifically say one way or the other, but I'm assuming the patient survived. That's what counts and these docs should be content with that. She sounds like a very sick cookie.

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Specializes in SICU, CCU, MCU, peds, physician's office.

The patient did make it throught the code with me, but she ended up coding twice more during the night and did not make it through the night. She was so sick that I am glad she is not sufering any longer.

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Specializes in Cardiac Telemetry, ED.

Sometimes pages take a while to go through. Our cardiologists frequently experience delays receiving pages. It's frustrating.

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