Friday, November 21, 2008

Code Blue

Last shift I worked, I came in to get report. J had recieved a new pt, who honestly, looking from the door looked like the foot was on the bannana peel. I asked her "why's he here and not in ICU?". "Oh, well they will have a room for him when the relief gets here...". "Ok, I tell her, I'll get report on the rest of my patient's from the other nurse and by that time the ICU nurse will be ready for report...no need in giving report to me...and me giving a 2nd hand report to ICU is there?" "Uh, OK she agreed (relunctantly because she really wanted to just leave and go home). She had had a long day. I had given report to her in ICU that morning and she had transferred patient's out and they had floated her to tele and given her a butt-load of admits. She looked like she had been basically run through the ringer.

Half-way through my report, J interrupts to tell me that the Powers-That-Be had decided to leave the patient in Tele because "he is doing better" (!). I asked her, if any of them had stepped out of their ivory office to take a peek at the man, because he doesn't look too good. She assured me that he looked better than he had on arrival, and had on his C-Pap and was resting.

I finished my report, then she starts giving me report on the "Banana Peel" guy, I'm looking in the door and I stop her cold...."Let's just go in the room, so I can be checking him out while you're talking, because to me he doesn't look good". "He's got a foley, and it's draining good, and he got lasix and he had C-pap, he's X-years old, and he seems to have some sort of sleep......."

At this point I interupt her, my stethoscope on his chest...."He ain't breathing!" "Uh, she says, his chest is going up and down.." "Yup...that's the C-pap working...he doesn't have any lung sounds..." I start trying to wake him up, shaking him ... doing sternal rubs...calling his name. Hey, J , was he responsive when you were in here...? "He was talking to me", she says. "Well something ain't right now...he's out of it...is he diabetic (I'm observing the ring of sweat on the bed, feeling the patient's skin which is diaphoretic and pale). "No"...

GET THE CRASH CART NOW.....I call the Supervisor for rapid response team, and call respiratory for rapid response team.

The Supervisor comes in and I let the Powers-that-Be know the situation...IE: He isn't moving any air, but he has a pulse and is sinus rhythem...

By this time respiratory is there and checking the O2 sat...which was to say the least dismal....We hit the button...Code Blue...and the rest of the team arrives. The er Doc tubes the guy, but they cannot get it in position, and bagging him is making him puff up like a puffer frog. The man had two docs working on him trying to get him intubated and an OG To get the air out of his stomach. In between we were getting good sats with bagging, just blowing him up like a puffer frog. Mid-way through he had a seizure (damn that sure isn't a good sign!), they finally got him tubes and over to ICU...where they had to CALL IN THE ICU nurse they had put on call. Didn't save any money there folks.

Last I saw, the guy was still tubed and looking pinker, but sedated...don't know how that will turn out. J stopped on her way out 2 hours late and thanked me for looking at the guy with "new eyes", because to her he looked better, and sometimes appearances can be deceiving.

The rest of my night was pretty good except I had one patient that the family even wanted me to come out of the CODE because their mom had some blood in her spit....hello....that's not life threatening...I'll be there when I'm thru here...saving a life...got it folks??? Later they complained to management that "I wasn't treating them right"....hummmm was it the code when I wouldn't desert my patient to look at spit...or was it me asking them to quit sucking her tonsils out through the yanker because she was gagging and that was putting her in pain (gallstones people!!!) and we had just pulled out the femoral line and there was that little bitty thing about possibly causing her to start bleeding....YOU KNOW talking common sense to the contrary!!!!??? I'm just a bitch I guess. Anyhow, my boss just shook her head...and went to her office..., you just cannot please everybody and GIVE GOOD CARE at the same time!

14 comments:

Sue said...

Jeez.

Reddirt Woman said...

Dang

Some people are soooo inconsiderate. If it had been there mom coding I bet they wouldn't want you to leave. Now if mom had been blowing blood all over the room, that might have been different. I guess I'll have to think that they were just so scared. Give 'em the benefit of the doubt.

Helen

Reddirt Woman said...

dadgum proofreader... 'their' mom..oops.

GingerJar said...

I was in the room with their mom about every 5 minutes the first two hours and every 30 minutes thereafter ... and she wasn't critical...I tried to keep her comfortable...but everytime she would close her eyes...they would wake her up to see if she was o.k. I suggested that they stop waking her up...but just sit beside her and let her rest. No Go...all night with the yanker....sucking on the tonsils....no wonder she was having a little blood in her spit...they were causing it!

Mary Ellen said...

Wow - I guess you don't have many boring days at work! I'm pretty sure I couldn't take it. Nurses are vastly underappreciated.

Thanks for stopping by my new blog. It's amazing how many lives are touched, even a little, by adoption. I appreciate your sharing the story with me.

Debbie Y. said...

I don't understand people, I guess. You can't please them at the best of times. They probably knew you had your hands full and just wanted medical attention because they are needy people. You are a much better person than I. I guess that's why you are the nurse and I am not.

Ness said...

There are the great nurses like you and then the one my 89 year old ex-father in law had today who put him in a chair after hip replacement surgery 12 hours before(he broke his hip at home) without him being poseyed and by himself in the room (he's still confused and combative from the anesthesia and Morphine)and he fell out of the chair into the floor and has a major bruise on his temple. He has never been in a hospital before and very independent to the point that last night he kept wanting to get out of bed before the surgery. When I was a nurse, such behavior was given in report so the next shift would know what to expect and I would have never left an elderly, confused patient up in a chair for the first time alone. His roommate's family said my ex FIL had been extremely agitated and confused all morning.

GingerJar said...

Ness, I hope your FIL is better today. Sometimes the pain med can make them confused. Sometimes it's the new environment. They really need to watch...he's age and the hip sx put him at high risk for pneumonia...and one of the first signs can be confusion (in the elderly) and it can be hard to catch when they are already confused. I cannot believe they got him up for that long the first time! I'm no good in ortho...I want to give everybody pain meds and back rubs! I just feel so badly for them hurting. My mom broke her wrist and hip at the same time when I was visiting her in North Carolina. She was in rehab for 6 weeks. She was miserable most of the time...and there wasn't much I could do for her.

jeepgirl said...

Oh for the love of god! I love when families have something more important to tell yu (or show you) than the code you are working. I had one walk in on a code in the ER asking for a pillow!

As for the gigglebox post, I had one of those last night when I got report. I was drinking my starbucks, happy as hell. The nurse proceeded to tell me a story about our clerk (a pre-op trannie) and I alghed so hard that I had to spit my coffee out in the trash. I think I was sitting on the floor in tears from laughing so hard!!!

Anonymous said...

i'm leaving this anonymously because I know I will come off sounding like a b*tch....

But if you are going to blog with the tone that you are an awesome nurse providing awesome care (which you probably are and you probably do).....you might want to make sure you spell stuff right. It will help your credibility.

You said "rhythem" - I think you mean rhythm.
You also said "yanker" for the suction reference......I belive you mean Yonker suction.

Not trying to be a jerk.....but as a nurse myself (who has also in the past been one of the "eat your young" type of bad-ass nurses - have since reformed to actually being nice now).....it really makes you look unprofessional to have mistakes like that in your blog.

ok - you can rant and call me names now if you want.
:)

Sue said...

Anonymous,

AHAHAHAHAHAHAH. Maybe you should try proofreading your OWN words before you critique somebody else.

Thanks for the laugh today!

shrimplate said...

.I belive you mean Yonker suction.

I ken haz hammera to sok diz azzhol in hed?!

Y-a-n-k-a-u-e-r, spelled out right there in the little package thingie.

Anonymous said...

you are right.....i did spell yankauer wrong.....my bad. (I googled it before I put it in my comment because I couldn't remember how it was spelled........but I did know that it wasn't "yanker" like the original post stated).

Anyhow, glad I could provide a laugh! I had to laugh at myself too... :)

My point of the whole comment was to try to bring to light that as nurses we have to try to not be the bad-ass self-adoring bullies that a lot of us turn out to be (myself included in my ER days.....I was the worst). I feel like I gave that up though, part of the reason I gave up the ER......

Anyway, I'm glad that the blogger here did the right things for her patient - way to go! that's awesome......I was just trying to subtly make an obeservation about nurses in general (again, myself included).....that our profession would get a lot more respect, a lot more refined and a lot more intelligent if we approached each other with a sense of care and education instead of a sense of self-preservation and bullying.

that's all......

anyway, happy turkey day.

GingerJar said...

Hummm...so I came off sounding like a bully...when the person who actually did not even hear me spending over 30 minutes...at a time carefully explaining to the family why it was important to be careful while suctioning...showing them how to do it properly and....yes .... actually praising them for taking such good care of their mom. I did figure out that most of their "complaints" and / or questions were because they were scared spitless. Oh, and I have trouble with the proofreading thing, because when I try to make corrections on my blog it disappears and is gone forever and that is a pain in the ass.