First Rapid Response

4 Hey! so i have now been off orientation for about 4.5 weeks. tonight was my first rapid response ever. it was really scary and i kinda cant believe it. basically the short story is i have report on a pt and she is late 70's who broke a few ribs on the left side. when i arrive im told she has been SOB all night and day. so i check on her and yes she is in fact sob. but not too significant she is a+0x3 and is pleasant able to tell me she is doing ok and will let me know if she is having a more difficult time. well i kinda had a bad feeling about her from the moment i looked at her but had nothing else to really base it on. flash forward now to 7pm. she has gotten an order for xanax for her agitation (her o2 sat was 97%). i had her on a venti mask 50% 02 and she was doing well. breathing through her mouth a lot. id been checking on and shes been doing ok. now to 845. i go into her room she is naked, agitated, and her face is beet red. call the rapid response. the doctor comes in decides its the medications she was given (also got 1mg of morphine for pain). so shes now on a rebreather and oxygenating well at 98%. he tells me to "do abg's if she desats again otherwise dont bother".

well now im feeling ok. shes oxygenating well. so give me like 15 mins and im uneasy again. clinically shes doing ok. but physically i believe shes struggling. so i put in the order frm the doc for the abgs. the doctor comes back up after i called him saying i thought she looked bad and the resp therapists could not get the abgs. he comes and does them. snaps at me about the portable chest. just all around cranky. now its 1030. he gets the abgs and says "so and so is taking over at 11 call him with this problem"

the portable chest gets done and it turns out her left lung is basically nil. pt is transferred up to the icu and intubated. omg.

this was my first ever rapid response and i feel as if ive run a marathon! of course since it was my first i was so caught up in looking after her i forgot to call family (which i apologized for but live and learn)! i just feel really sad because she had been ok earlier in the day. it all happened so fast. thank god other nurses were there to help! i know it takes a while to know just how to get it all done (proper charting and what not) but i guess i just get so wrapped up in making sure shes doing ok the other stuff gets behind. this job is so hard sometimes. like today. i learned a lot from it i guess. for next time. and there will def be a next time. i feel like i did the best i could and really what else matters other than that?

and ya i just realized the story is not short.
Sometimes things just have to play out because there isn't anything concrete to "fix"... doctors like to 'fix' things....nurses (well, hate to generalize-but for discussion, I'm going to go out on a limb) like to 'take care' of things....

it was all very stressful. but i feel like i advocated for her as my pt and went with my instincts. i know everything will come with time.

Sounds like you did fine

itll get easier right?

Yep... but there are always patients that throw a wrench into things, and don't follow the 'book" description of problems. That's when the "gut" reaction kicks in.... It's never easy to see a patient get worse- but if you can get them to the next level of care as well as possible, sometimes that's a really good day

Does it get easier yes and no. Depending on your doctor trying to explain how your gut is telling you something is wrong without proof is always diffciult but getting to trust your gut becomes a lot easier

OK, I think you did everything right, went with your gut, and you should be proud. I think I was really really nervous on my first RRT. But I read the first few sentences and said "Pneumo, where's the chest x-ray"I'm not saying you should have sad this.....I've been in the field for almost 6 years and in ICU....But how did a doctor not say this much earlier when she was SOB?

Congratulations! As a new nurse, it's SO important to be able to trust your gut - when you get the "oh no, he/she is going south" feeling again you can act on it more confidently. You should be really proud, USE that intuition. It's the part of assessment that starts at the door, looking at the patient. Two tidbits to keep in mind the next time you get that feeling: 1) Mental status changes and craziness like you saw are often a sign of respiratory distress, they could be retaining CO2, they could be working too hard to breathe, they could be compensating because of the extra O2 you're giving them... only the ABG and chest x-ray will give a clear-er picture of what's up. 2) If a patient has higher O2 needs over a shift and ends up on a non-rebreather mask it is generally a BAD thing... I like to think of it as the last step before ICU and intubation (unless they are hospice, or DNI). Keep a close eye on those patients....3) If a patient is going south, it always helps to grab a nurse whose advice you trust, look at the patient with him / her, and brainstorm what may be going on and how worried you should be. It will help focus your communication with the doctor. Experienced nurses do this too! Congratulations again!

the doctor originally thought that the reason she was not responding as well was because of the xanax and morphine seeing as she did improve with the non rebreather. in all fairness to him she did look ok with the numbers but i thought she looked bad otherwise since i had seen her earlier in the day i knew it wasnt normal.the second time i called him i asked if he wanted a portable chest and he became irritated with me lol. the other nurses i was working with were surprised he didnt order anything. they said if it had been any other doc she would have been placed on the unit the FIRST time. it took another doctor for them to place her.

Quote from katielam616it'll get easier right?

You did just fine! There is no 'right' way to handle a rapid response especially you're 1st one. You saw a dramatic change in condition and followed protocol but most importantly you stayed with your pt. Sorry that doctor was a jackwagon to you but you can't control when you're pts decide to crash, he'll get over it. RRT: the T stands for "team".

when they looked at the xray her xray was worse from the day before so this had all been building up from the night before. basically with the hernia on the diaphragm the pts stomach and intestines were up in her chest so the new doctor didnt want to put in a chest tube because he didnt know what he was going to get into. so they were doing a cat scan after they intubated her.