Specialties Emergency
Published Nov 30, 2011
Not necessarily just for the ER RN's... any case in the clinical setting.
FlyingScot, RN
2,016 Posts
and flyingscot, I've also coded someone and ran into them a few days later in the grocery store holding a case of budweiser and carton of marlboros. nothing like getting a new lease on life!!
The weird thing is we not only coded him but pronounced him after being assessed by multiple skilled medical practitioners and an US confirmation of no cardiac movement and we had stopped all care for a prolonged period of time. I was in and out of the room afterward cleaning up and whatnot and he was still dead. It wasn't until about 30 minutes later when I went in and noticed subtle changes like the tips of his ears were pink that I realized something had happened. I threw open the curtain and yelled out "Dr. N he's aliiiiiiiiiiiiiiiive!"
Cat_RN, ASN, BSN, RN
298 Posts
I don't work in the ER but did have something strange happen recently. CNA reported pt had o2 sats in the 70's. Enter room to find pt acrocyanotic with the rest of their body deathly pale. Distal extremities are ice, ICE cold. Pulse ox. is going between 55-68% to not registering at all. Pulse on the the machine mostly isn't registering but when it does it says 25-38 bpm. I can't get a manual BP, not even a palp BP since I can't feel a radial pulse any way. I also can barely hear any kind of Apical pulse at all- not really enough to count. I get another RN to assess who cannot get any vitals either. Meanwhile, not only is the pt awake and alert, but they're NOT even really SOB, they are talking, and asking for a sip of water and for us to call their spouse because if they are going to be transferred or die the spouse needs to now where they are!
When the paramedics arrive they too cannot get any BP, O2 sat or hear a pulse, and the EKG confirms the pulse is 20-35. They take the pt away and they're still hollering about calling their spouse and that they are a "NO CODE! DO NOT RESUSCITATE!"
I've never had a pt be pretty much 'absent of vitals' and still talking coherently. Crazy!
zorro_wrangler
67 Posts
Saw Dr. P resucitate a pt. with a cardiac thump (apparently thats how it was done in the good old days before CPR). I thought it was pretty interesting.
Watch it Buster. Some of us remember those "good old days"!
Actually..that's called a pre-cordial thump and was and still is sometimes (on very rare occasions) used to convert v-fib.
SAHMnurse
36 Posts
1. Abdominal compartment syndrome in a 12 year old. Tragic outcome on that one. 2. Mesenteric venous thrombus resulting in ischemia and necrosis of the entire large and small intestine caused by BCP's. Also tragic outcome. 3.Old guy. Full arrest in the field, completely smurfed from the chest up. No cardiac activity on US after multiple rounds. Asystole on monitor. Went in to do morgue care 30 minutes after code called and ALL care stopped. Ears now pink and patient with slow but spontaneous respirations. Saw him 3 days later outside smoking!
Seriously? That is interesting.
Esme12, ASN, BSN, RN
1 Article; 20,908 Posts
as someon already mentioned it's called a Pre-cordial thump and it was used for a "witnessed arrest"......and it would work! We still had CPR :grn: but if the pre-cordial thump worked we didn't need it.
That reminds me of a story. Back in the old days we would go out for liver rounds in uniform (that's right white from head to toe but no caps allowed!) at a place called the Recovery Room. One night when we all walked in after a hellish night at 1 am some moron.....I mean gentleman.....grabbed his chest, screamed in pain and fell dead off the bar stool straight to the floor. My friend jumped on the guy's chest before any one else could think and gave him a pre-cordial thump to which he grabbed his chest, sat up and replied...."What dya hit me for!!!" To which my friend replied you son of a #%*&^ and promptly socked him in the lower jaw promptly knocking the guy unconscious......:hhmth::hpygrp: as well all fell on the floor peeing our pants with hysterical laughter. The guy never tried to fake a heart attack again..... Oh I miss those days......
LouisVRN, RN
672 Posts
Both instances of adrenal insufficiency that I've seen were really interesting. As was the case of steven-johnsons syndrome - something i will nver forget.
sapphire18
1,082 Posts
Creutzfeldt-Jakobs disease in a 50 yo female- she went from going out dancing with her friends to unable to eat/walk/talk and combative the next week...died after a couple more weeks. Brain looked like swiss cheese on ct/mri with the holes getting bigger and bigger...very sad.
as someon already mentioned it's called a Pre-cordial thump and it was used for a "witnessed arrest"......and it would work! We still had CPR :grn: but if the pre-cordial thump worked we didn't need it.That reminds me of a story. Back in the old days we would go out for liver rounds in uniform (that's right white from head to toe but no caps allowed!) at a place called the Recovery Room. One night when we all walked in after a hellish night at 1 am some moron.....I mean gentleman.....grabbed his chest, screamed in pain and fell dead off the bar stool straight to the floor. My friend jumped on the guy's chest before any one else could think and gave him a pre-cordial thump to which he grabbed his chest, sat up and replied...."What dya hit me for!!!" To which my friend replied you son of a #%*&^ and promptly socked him in the lower jaw promptly knocking the guy unconscious......:hhmth::hpygrp: as well all fell on the floor peeing our pants with hysterical laughter. The guy never tried to fake a heart attack again..... Oh I miss those days......
Watch it Buster. Some of us remember those "good old days"! Actually..that's called a pre-cordial thump and was and still is sometimes (on very rare occasions) used to convert v-fib.
Ok...will let Dr. P know that thats what its called - a pre-cordial thump .
Perpetual Student
682 Posts
Apparently it's a known potential complication, but the most interesting thing I've seen was a pt who presented with a ruptured spleen caused by a colonoscopy. My colleague and I recovered her after her splenectomy. Makes the thought of a colonoscopy even less appealing. The scary thing was she'd had it done elsewhere, gone home, and presented to our ER because she felt lousy and weak.
NickiLaughs, ADN, BSN, RN
2,387 Posts
I'll bet it was Tetnas.....http://www.dhpe.org/infect/tetorifice.html I saw that once and will never forget it.
I recall they were thinking that as one possibility. Guess it was hard to know, we couldn't get a health history from him and his family was back in China. He had some unusual skin rashes on him as well.
ErinS, BSN, RN
347 Posts
This is the WORST disease I have ever seen. In 3 years I have had 3 CJD patients, all in their 50s. They go from fine to dead in less than 6 months, and the restlessness is incredibly heart breaking.