This happened in a new hospital halfway between london and bristol, in about 2004. I had got tired of all the agency work in A&E in London, so signed up for a 3 month contract in a general surgical ward working nights.
I had some bad experiences straight away - as in no handover on my first shift, and I confronted the hardened battle axe of a nurse who was finishing the day shift as she was about to leave the ward. She told me that all the patients were fine - and left.
But that's another story, but suffice to say, I stuck with the place for two months, and things only got worse, and I had to quit. But one incident happened, and I felt that I was the only one in the hospital who could see this problem, and to this day I still think I'm in the right, although I do have some doubt now. So here's the scenario.
Mrs Smith had cellulitis of her left calf (it wasn't her real diagnosis as I can't remember, but I do remember she did not have a particularly serious problem). Anyway, I'd been giving her the evening IV AB,s and got to know her well as she loved to chat. She was one of the more lively patients in her 6 bedded bay.
Anyway, I turn up to work (I think about 2000hrs) and I am told by the charge nurse that Mrs Smith is 'unconscious.'
I'm thinking, okay, what happened, where is she now? I'm then told she is still in the bay at the end of the ward, unconscious. I can't believe my ears. An unconscious patient, regardless of cause = unprotected airway. It all goes back to ABC. I tell the charge nurse that this can't be right, but he then explains that she's had a CT, been seen by her consultant, been seen by the medical team, and been seen by the neurological team, and they cannot find a cause, and all scans are normal.
I am told that there is nothing to do, but to leave her there.
You may not believe this, but neither could I.
I explain that this is crazy. We have an otherwise healthy 60yr old woman with an unprotected airway, at the end of the ward. The charge nurse gets a bit angry, and tells me if I'm that worried, I can spend the night at her bedside, but that's up to me, and I still have 11 other patients for the night. All I wanted was for her to be somewhere where she could be observed, as a simple aspiration and she's gone. An otherwise healthy woman could be dead in a matter of minutes. She's on no kind of monitoring, absolutely nothing.
What should I do? I contemplated walking out. I contemplated complaining to the duty nurse supervisor, but found out she was ok with this as well. I stayed for the shift.
I managed to go past her room about every 15-20 minutes - pathetic really, but the best I could manage, and every time i tried to wake her.
At about 0300hrs I tried waking her, and she woke up, asked what time it was, and seemed completely fine.
You probably won't believe this, but this is exactly how it happened. I've never seen someone suddenly go unconscious for no apparent reason, and suddenly wake up hours later absolutely fine.
I called the house surgeon and told him about her, and he was like 'why did you bother calling me?' and I told him that it was a bloody miracle she was still alive, and that he might want to assess her while she's still conscious, because who knows what could happen. He agreed to come down and do an assessment.
Anyway, I worked there a little bit longer before an even worse event forced me to quit, but I'm curious what you think. Should she have been in a monitored unit? Should she even have been intubated? Was I over reacting?
I always felt I was in the right on this one, but it seems I was the only one in the hospital who felt that way.
enuf_already
789 Posts
Had she consumed a large amount of food and suddenly had no bowel sounds?
I personally see no reason for her to be intubated or that her airway was somehow compromised. You place her at a bigger risk of aspiration if you intubated her for no good reason. Then you can proceed to kill her with a nosocomial infection.