Friday, September 23, 2005

Our First Code

Gina & I got asked to work at #1 hospital on Sunday night with the offer of a $100 bonus. We gave them some conditions of our own first - we both wanted to be on the 2nd floor & on the same wing.  Of course they said ok, what else could they really say?  We got to work & sure enough were both on the 2nd floor - but they had Gina on the north wing & I was on the south wing.  Nope, not  We went to the charge nurse & she gladly changed it so that we were both on the north wing = happy.  It's just nice working with a friend.  I don't know why they are so set on splitting us up all the time.  It's not like we are slackers if we work together.  If anything, we work better. 

Anyways, they overloaded us with patients & we had no patient care tech - that's getting typical at this hospital.  Towards the end of the shift - like 5:30 am - the other nurse was walking her pt from the bathroom to the pt's bed.  This was a little old lady - I don't know what her diagnosis was, but she had been alert although somewhat confused.  She kept asking me to look in the kitchen cupboard to find out when her husband's doctor's appt was & she asked why he was depressed.  Umm, I don't know.  So out of that room we hear very calmly:  "Guys, I need some help."  Gina & I went in thinking that the pt fell...because she was on the floor with the other nurse trying to pick her up.  Nope - she was not breathing - no response...nothing.  Gina & the other nurse are picking her up, I get on the other side of the bed & get my arm under the pt's arm & we heave her up onto the bed.  I take a look at her face - her tongue is protruding out & there is no sign of life.  We tell Gina to call a code while the other nurse checks for a pulse & starts compressions.  Gina goes out to the nurse's station to pull the code button, I went to get the crash cart....within 10 seconds, there's about 3 other nurses in the room (ICU is like 20 ft away).  30 seconds later, there's about 10 more nurses there.  Our clinical leaders are looking at the monitor at the nurse's station where the pt now has a heart rate of 72 & normal sinus rhythm.  All we keep hearing over & over is "Why did they call a code???"  Ummm.....because she wasn't breathing!!!!  So they scanned back on the monitor to see what took place & sure enough.....there were very long one heartbeat every 30 seconds or so for a few minutes.  That seemed to get the clinical leaders to shut up & stop accusing us of calling a code for no reason.  Gina & I were so panicked during the code because we've never had to actually participate in one before.  I mean we kept calm, but I think we were both clueless as far as what exactly to do.  Looking back - I probably should have stayed in the room with the other nurse while Gina went to call the code.  Someone else would have grabbed the crash cart on their way in.  Oh well, I suppose the only way to really learn is by taking part in them.  We aren't expected to be experts.  The pt seemed to be fine after all was said & done.  In fact, she was asking to get up & go to the bathroom again.  Ummmm...don't think so.

Mon, Tues & Wed we were at our other hospital.  I cannot stand the beginning of shift there - it is just such a mess.  Maybe it's the fact that we are with preceptors & are still under their guidance to a degree.  I have my own way of organization & don't like when that gets interferred with.  For example, I like to get report, go check on my patients & do an assessment, then take the time to review the latest orders & lab/test results.....then pass PM meds & start charting.  The nurse I was with on Monday night seemed more interested in what the chart read than the actual patient themself.  She spends like the first hour or two catching up on that stuff rather than assessing the pt.  The other two nights were better because my preceptor had no problem with me being independent & on my own.  Not to mention I was carrying the majority of her patient load while she was doing charge nurse stuff. 

This floor or maybe it's the hospital is so opposite of my first hospital.  For of Gina's pt's had a 6 beat run of V-tach.  She looked up his labs only to find out his am K+ was 3.2 & not addressed.  It's like they don't realize how important potassium is for cardiac function.  So Gina had to call & get an order for potassium to bring up his level.  Doctors just love getting calls at midnight as opposed to sometime during the day...don't they????   

At about the same time Gina's pt has his V-tach, I also had a pt do the same, only it was a 12 beat run of V-tach.  I didn't find out until over an hour later...nice, huh?  Do they not realize V-tach is not a good thing?  I was about to call the doctor when my preceptor said "Let's get her K+ & Mg levels first."  So she orders them & we have to wait for lab to draw them & get results.  By the time I called the doctor, this episode of V-tach took place 2 hours earlier. Luckily the pt was non-symptomatic & remained normal sinus rhythm.  She was a little low on Mg (1.6) & K+ was ok (3.6).  I got an order for Mg & K+ as well as putting this pt on the electrolyte protocol.  Which is another thing I don't understand - why more pts aren't automatically put on the protocol as soon as they are admitted (unless they have contraindications).  ESPECIALLY when they came into the ER with a K+ level of 2.6 & are admitted with a diagnosis of hypokalemia & the doctor has them on lasix.  I just don't get it.

I had another pt (27 yr old with pancreatitis) whose blood pressure was 191/112.  Granted, his diastolic had been wavering around 100-105 for the past two days, this was the highest it had been.  I asked my preceptor/charge nurse if I should call the doctor.  She said nope.  Instead we gave him some pain medicine & his morning dose of Lopressor early.  That seemed odd to me.  At my other hospital, there would be no question that the doctor would be called.  Gina was baffled - could not believe that they were not alarmed with that high of a blood pressure.  We later confirmed it with one of the hospital supervisors/ICU nurse that no, the doctor would not be called in that situation.  Bizarre!

Ok, I'm up way later than I planned - I need to get some sleep.  Hope everyone in Hurricane Rita's path got out of town & that it isn't too devastating.  I know the anxiety that comes with preparing for a major hurricane as well as the traffic jams.  Let's hope those idiot news reporters don't stand out in the wind & rain in order to convince us that it's windy & rainy.  It seems like there's always a few that do that which I think is dumb.  Then you have one or two that act like they nearly got hit with debris, right?  Anyways...let's all say some prayers for those in Tx & La. 

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