The first time your pt crashed

[tech1000]

I'm a new ER nurse (but have worked in the ER for 2 years) and the other day my pt that had been pretty stable for like 4 or 5 hours crashed out of nowhere. My preceptor was nowhere to be found and I wasn't really able to think clearly. I knew exactly what to do, it just didn't come to me (the patient survived- I had already found another more experienced nurse who ended up taking over the situation). So, do you guys remember the first time a patient crashed on you and how you handled it? I assume it can only get better next time, but I was still disappointed in myself.

[Biffbradford]

The very first one was on orientation. I had just walked into the unit and saw them coding someone (ICU). "Throw your coat in the corner and punch in. He's yours!"

Had one sitting in the chair, brushing his teeth ... then boop - out went the lights.

Another sitting on the edge of the bed, sipping some water and he simply stopped breathing. 30 seconds later I'm doing compressions on the guy. He didn't aspirate, he barely got his lips wet. Too much excitement I guess. He spent the next 2+ months on the vent.

Cripes!

[murphyle, BSN, RN]

The first time I had a "stable" patient go down the drain came about eight months into my nursing career. I'd been on scads of resuscitation teams, dealt with everything from chest pain to respiratory failure to massive trauma, but I'd never had one of mine crash.

The patient was a hypertensive but otherwise healthy guy, in for acute exacerbation of chronic cholecystitis, and was scheduled for cholecystectomy later that morning. I was in taking care of one of my other patients, another nurse walked in to check on this guy, when he suddenly began to complain of "stomach pain" different from the RUQ pain he'd been having. She called me in, saying "He doesn't look right"; I walked in the room to find the patient gray and diaphoretic, with a major sinus brady of 35 down from the 60s, and his BP had dropped from 140s/90s 5 min previous, to 70/30 at that point. I laid him down flat, opened his IV bag wide open and grabbed the MD... and just as she walked in, the patient's eyes rolled back and he flatlined. No joke, no error - no palpable pulses and the monitor beeping "ALARM: ASYSTOLE." I yelled "Call Resus, now!" as the doc and I ran him down the hall to the trauma bay, doing this resuscitative three-legged race in the process (one of us on either side of the stretcher, both of us doing one-armed compressions with one hand on top of the other).

The guy woke up as we were pulling into the bay. Opened his eyes, looked around at the assembled team, and said "What happened, why is my chest so sore, and why are you all looking at me like that?"

Of course, surgery was off the table at that point, and the patient went up to Critical Care for a cardiology workup (with a monitor and one very cautious nurse escort). The culprit turned out to be his metoprolol from home, which he'd taken a couple of hours before arrival. BP dropped, HR dropped and bang, down he went. He walked out of the hospital two days later with no cardiac or neurological sequelae at all.

I figure that incident counted as my cardiac stress test for the year!

[canoehead, BSN, RN]

Called the code, and this smart aleck ER doc comes up there, impatiently stating, "I've got a man in the ER having chest pain." I just looked at her and said "Is he alive?" She said yes, so I told her to "Run this code."

Her ER nurses would have said the same thing, perhaps in unison. Good going.

[thelema13]

Just the other day, I had a 75 year old male come in with chest pain. Poor guy was on the way out of town with his wife to go on a cruise. I triaged, got an EKG, started a line, drew labs and informed the doctor. Grabbed a 250cc bolus, aspirin and on his 2nd nitro pill, he bottomed out and coded. Got him back shortly after doing some compressions, dumped 3,500cc of saline into him, BP ~40/20s. During my triage he told me he took viagra, but not for 3 weeks. After we stablized him, I started asking him more questions, and he admitted he took a viagra before they left the house. This guy was in his 80's and was going to try and get his vacation started on the drive to the ship!

[MissBrie_123]

Bless you. As an ICU nurse I have been guilty of being judgemental of regular floors when I receive patients from them; however I now know that I could never handle the demanding position of a med/surg nurse. I am comfortable with the sickest patients coding all day but I have true respect for floor nurses that magically care for so many patients.

[turnforthenurse, MSN, NP]

The most memorable one happened to me out in triage.

Pt came in, mid 40's with SOB and chest pain. It was just myself in triage with a tech, lobby was full and more patients were checking in, of course. I had a really bad feeling in my gut so after I brought them back I stayed with them to get them checked into the computer and to get some more history regarding their CC. The nurse that was supposed to have this room was busy with another patient. While the tech was doing their EKG the patient seized without prior history and then arrested immediately after. The patient ended up having a huge MI and ended up living.

It bothered me for a long time because I was the only nurse in triage with that lobby full of patients and I abandoned my post...what if something had happened out there while I was gone? What if I had left that patient who ended up coding in the room by themself and went back to triage because our policy states there must be an RN out there "at all times?" After awhile I realized that I did everything I was supposed to with this patient.