Just another day.
I’m going to stop saying “I haven’t called (code colour or MET reason) yet, so I’d have no idea what to do”. Last time I used it as an excuse for why I didn’t know the answer to a question in an assessment (haven’t called a MET for low resp rate yet, so I don’t know exactly) and the next day I had a patient breathing about 4 times a minute who I had to call. It was funny then, not exactly at the time, but a few minutes later. Yesterdays one was not funny.
I had a patient that was the best day one post knee replacement I have ever seen. Very with it. No history of anything major. Elective operation so reasonably healthy. Transferred to the wheelchair by herself, moved around in the bed by herself and was generally a really lovely lady. Physio got her up and walked her a good five metres, one way. Turned around to go back because she started getting tired, very understandable. Got half way to where there was a chair and she’s looking a bit white. So they sat down for a rest, got her some water. Still fine. It’s not uncommon for someone day one post op to drop their BP when they get up the first time. So they get back up to go back to her room. She’s a bit out of breath, but that’s still ok. Bit hot and sweaty and pale, but low BP is kind of expected. And she did go a long way. I follow with the obs machine to see what we are dealing with.
One step from the bed she rolls her eyes back and falls into the physio.
Ok, slightly bad. Probably vasovagal. Lift her back to bed with the physio, hit the emergency button, call a MET. By the time I put the phone down most of the ward is there. A few minutes later the doctors are there. I’m trying to get a manual BP, but can’t hear anything. Can’t even feel any pulse at her wrist when I try to read it with my fingers.
Can’t feel a pulse. Shit. The nurse at patient’s head can’t get a response. Patient isn’t breathing.
I picked up the phone and called the code blue just as the resus trolley gets there.
Paddle stickers go on and patient takes one shaky gasping breath. Mask goes on. SpO2 is at 75%, but we have a femoral pulse, very sluggish.
ICU’s resus team gets there at a run, Consultant Doctor takes the head. Takes over the breathing. There is a heart rhythm so no shocks, no chest compressions. Still no BP. Doctors are putting in canulas so we can bolster the blood volume to try and get a BP back. Ward nurses are fumbling with minijets of adrenalin. The scribe is yelling the SpO2 every time it goes below 85%, people are yelling to the scribe what’s going into patient. ECG dots go on. BSL is done. ECG cords get tangled as two different people try to attach them.
Patient’s eyes flutter open then closed. Patient stops having a heart rhythm.
In a very calm quiet voice that carries over the chaos Consultant says “I think we might get some chest compressions now please”.
ICU nurse starts chest compressions. Doctors are still trying to put in canulas. Adrenalin is going into the one existing canula every 2 minutes. Gelofusion is getting prepared for when there is access. Intubation equipment gets handed into the room to Consultant who puts it beside patients head, just in case. Intermittent CPR continues whenever there is no femoral pulse. Canulas are placed and gelofusion is started with nurses squeezing it through to get a BP faster. Patient goes into AF from too much adrenaline. Three bags of fluids go through. Pulse is 209, then plummets. BP is 170, then quickly 50.
ECG is taken and looks crappy. Bloods are taken and run down to pathology. I have to answer a lot of questions to a lot of different people about the morning and the collapse while helping. Theories are passed about what happened. The leading theories are massive AMI or a PE. Patient is breathing but cannot maintain an airway. Muscles are too flaccid. Decision is made to take patient to ICU. Patient is intubated.
Physio is standing by the door looking as white as the patient. Nurse takes him aside and explains that its not his fault and that if she was going to flick a PE or have an AMI it would happen whether he walked her or not and him walking her meant we noticed right away so she may survive.
Portable xray arrives. Portable cardio ultrasound arrives. Chest is cleared of all sticky things so the beams can pass through. Room is cleared so we don’t get irradiated. Second ECG is taken. It looks slightly less crappy. I leave the room to write notes for ICU. CPR continues. Blood results return, no troponin rise, probably not AMI. Pt’s right heart is enlarged. Doctors amazed patient has no cardiac history.
While I’m writing notes patient in the next room complains that they are hungry. Wants toast and a cup of tea. I tell them in no uncertain terms who is my priority.
Resus trolley runs out of adrenaline. I run to ICU to get more. It is possible to get to ICU very quickly from my ward and if you arrive out of breath people pay attention to you. Adrenaline infusion started. Patient’s belongings packed. Patient’s family arrives. Doctor deals with patient’s family while patient is wheeled to ICU. Patient semiconscious during trip and her hands have to be kept away from tube. Patient transferred to bed and hooked up to ventilator.
I hand over and go back to ward. Ward is a mess, none of the other patients have had any attention for the past two hours. And its food time for staff, or it was about the time patient crashed. Everyone is starving, but no coffee is needed. We were all more than awake.
Throughout the day we hear little bits of news. It was a PE, she has practically no side effects from being dead for a little while, she will probably be extubated tomorrow. It was actually a reasonably neat code, though those things are never nice.
Still don’t know where the piece of another patient’s notes that I was holding when it all started ended up. Found my pen and name tag in my pocket after my heart rate slowed.
The not funny part that kind of is was that the day before a group of us grads had been sitting in the caff discussing different codes and what we would do during them. When code blue came up I said I’d have to wait until I called one to find out because I honestly wouldn’t know until then. Funny how life likes to teach you.
The bad part wasn’t the code. I have helped in code situations before, never that long, but same kind of deal. Shocks, CPR, etc. I have seen dead people. I have been in the room when people have died. But this one was my patient and she was my most healthy patient at the start of the shift. By lunch time she was in ICU...
I had a patient that was the best day one post knee replacement I have ever seen. Very with it. No history of anything major. Elective operation so reasonably healthy. Transferred to the wheelchair by herself, moved around in the bed by herself and was generally a really lovely lady. Physio got her up and walked her a good five metres, one way. Turned around to go back because she started getting tired, very understandable. Got half way to where there was a chair and she’s looking a bit white. So they sat down for a rest, got her some water. Still fine. It’s not uncommon for someone day one post op to drop their BP when they get up the first time. So they get back up to go back to her room. She’s a bit out of breath, but that’s still ok. Bit hot and sweaty and pale, but low BP is kind of expected. And she did go a long way. I follow with the obs machine to see what we are dealing with.
One step from the bed she rolls her eyes back and falls into the physio.
Ok, slightly bad. Probably vasovagal. Lift her back to bed with the physio, hit the emergency button, call a MET. By the time I put the phone down most of the ward is there. A few minutes later the doctors are there. I’m trying to get a manual BP, but can’t hear anything. Can’t even feel any pulse at her wrist when I try to read it with my fingers.
Can’t feel a pulse. Shit. The nurse at patient’s head can’t get a response. Patient isn’t breathing.
I picked up the phone and called the code blue just as the resus trolley gets there.
Paddle stickers go on and patient takes one shaky gasping breath. Mask goes on. SpO2 is at 75%, but we have a femoral pulse, very sluggish.
ICU’s resus team gets there at a run, Consultant Doctor takes the head. Takes over the breathing. There is a heart rhythm so no shocks, no chest compressions. Still no BP. Doctors are putting in canulas so we can bolster the blood volume to try and get a BP back. Ward nurses are fumbling with minijets of adrenalin. The scribe is yelling the SpO2 every time it goes below 85%, people are yelling to the scribe what’s going into patient. ECG dots go on. BSL is done. ECG cords get tangled as two different people try to attach them.
Patient’s eyes flutter open then closed. Patient stops having a heart rhythm.
In a very calm quiet voice that carries over the chaos Consultant says “I think we might get some chest compressions now please”.
ICU nurse starts chest compressions. Doctors are still trying to put in canulas. Adrenalin is going into the one existing canula every 2 minutes. Gelofusion is getting prepared for when there is access. Intubation equipment gets handed into the room to Consultant who puts it beside patients head, just in case. Intermittent CPR continues whenever there is no femoral pulse. Canulas are placed and gelofusion is started with nurses squeezing it through to get a BP faster. Patient goes into AF from too much adrenaline. Three bags of fluids go through. Pulse is 209, then plummets. BP is 170, then quickly 50.
ECG is taken and looks crappy. Bloods are taken and run down to pathology. I have to answer a lot of questions to a lot of different people about the morning and the collapse while helping. Theories are passed about what happened. The leading theories are massive AMI or a PE. Patient is breathing but cannot maintain an airway. Muscles are too flaccid. Decision is made to take patient to ICU. Patient is intubated.
Physio is standing by the door looking as white as the patient. Nurse takes him aside and explains that its not his fault and that if she was going to flick a PE or have an AMI it would happen whether he walked her or not and him walking her meant we noticed right away so she may survive.
Portable xray arrives. Portable cardio ultrasound arrives. Chest is cleared of all sticky things so the beams can pass through. Room is cleared so we don’t get irradiated. Second ECG is taken. It looks slightly less crappy. I leave the room to write notes for ICU. CPR continues. Blood results return, no troponin rise, probably not AMI. Pt’s right heart is enlarged. Doctors amazed patient has no cardiac history.
While I’m writing notes patient in the next room complains that they are hungry. Wants toast and a cup of tea. I tell them in no uncertain terms who is my priority.
Resus trolley runs out of adrenaline. I run to ICU to get more. It is possible to get to ICU very quickly from my ward and if you arrive out of breath people pay attention to you. Adrenaline infusion started. Patient’s belongings packed. Patient’s family arrives. Doctor deals with patient’s family while patient is wheeled to ICU. Patient semiconscious during trip and her hands have to be kept away from tube. Patient transferred to bed and hooked up to ventilator.
I hand over and go back to ward. Ward is a mess, none of the other patients have had any attention for the past two hours. And its food time for staff, or it was about the time patient crashed. Everyone is starving, but no coffee is needed. We were all more than awake.
Throughout the day we hear little bits of news. It was a PE, she has practically no side effects from being dead for a little while, she will probably be extubated tomorrow. It was actually a reasonably neat code, though those things are never nice.
Still don’t know where the piece of another patient’s notes that I was holding when it all started ended up. Found my pen and name tag in my pocket after my heart rate slowed.
The not funny part that kind of is was that the day before a group of us grads had been sitting in the caff discussing different codes and what we would do during them. When code blue came up I said I’d have to wait until I called one to find out because I honestly wouldn’t know until then. Funny how life likes to teach you.
The bad part wasn’t the code. I have helped in code situations before, never that long, but same kind of deal. Shocks, CPR, etc. I have seen dead people. I have been in the room when people have died. But this one was my patient and she was my most healthy patient at the start of the shift. By lunch time she was in ICU...