Priorities Can Kill: When Passing the Buck Gets Dangerous

you sound like supernurse, and to remember all those details, I applaud you! I hate to say this, but I'm glad to see more and more hospitalists LOSING their jobs, they are as useless as TITS ON A BOAR HOG! ANd I applaud you for your quick action, your accurate assessment, and getting all the help you needed for your patient in a timely fashion. You walked into a nightmare, and saw daylight. I'm seeing our doctors here more and more going to see their own patients in the hospital. I know hospitalists seemed like a good idea at the time, but like so many other things that do, right down the toilet.

This is an excellent post considering some of the recent ones discussing whether one bothers to use a stethoscope, do an assessment, etc. Something as simple as one lab value can give the team a heads up on impending doom. We are all human and make mistakes. Sometimes our mistakes kill. I'm glad all turned out well for your patient. It sounds like you did everything you could to save their life.

While the CO2 level might have been missed, I doubt that explains what happened with your patient. When a person is in acidosis they will become lethargic, even unresponsive and potentially stop breathing if not addressed, but that is usually a gradual process. The dramatic crisis your patient had most likely was a PE, flash pulmonary edema, ARDS or even an MI. You did the right thing by using the emergency response team. They are there for an extra level of support, with an ICU RN, protocol orders that can be initiated before you can get ahold of the Dr so the patient can be stabilized without coding. Even if you knew what was going on you would still need them to get the patient intubated and transferred to ICU before they coded. Ask the ICU nurses what actually happened they probably have an answer after all the tests and treatment in the ICU and you will probably find you did nothing wrong and the acidosis level you are worried about wasn't the primary reason for the patient's distress.Things to do to expand your knowledge is take ACLS, attend a critical care conference, get certified in your specialty. Time and experience itself will increase your knowledge base and expertise so you will have a better idea what to do and suspect the next time this might happen. ACLS is very beneficial to increasing comfort level, knowledge and skill re acute situations, what to do, what meds and treatment are in order. These are just some ideas to increase your comfort level for the future. A silent prayer is always good too like you did. It certainly can't hurt!

Propofol can be hung in bags?

Thank you annabelle123456 and xoemmyloex! I had a great time writing this article, and to be quite frank, it's an important story to share. I learned so much that day. Brainstormin' -they hang propofol drips in the ICU to keep a patient under sedation while intubated and on the vent. Brandy1017, thank you for your comment. I'm so glad you mentioned what you did. I am ACLS certified, but so much happened that day that I didn't understand. This is what I left out in my story... The rapid response nurse came back after my patient was settled in the ICU. She made a point to come and debrief the situation (I LOVE this about codes and rapid response situations). What we learned as we sat there at the computer and read through this man's chart was that he had kidney issues, COPD, heart disease, diabetes, and many other comorbidities. The CO2 level was the last trigger, the last straw so to speak, in a long line of health issues that led to the cascade of his metabolic acidosis. Long story short, all of the issues this man suffered from caused his body to compensate for a VERY long time. By the time I saw him, his body was deteriorating to the point that the compensation was spent and his resolve had grown too tired to fight. His medical history showed kidney disease that warranted hemodialysis, but he was on the cusp (so much that no physician was ready to dialyze him yet). Interestingly enough, dialysis would have been a GREAT (long-term) resolution to his kidney issues. I remember the nephrologist walking out of his room at one point saying "I can't touch him yet, he's too unstable. We need to get him better and able to withstand dialysis." So, here we were at a crossroads. Another moral of this tale, be ready to learn. My debriefing was the BEST thing to happen in the immediate aftermath of this rapid response. It's amazing to know how much there is to learn, that the curve is great, and that every day has something new, a stone yet to be turned. Thank you ALL for reading my article and supplying your fantastic comments. This circumstance is one that has led to a cascade of opened doors that I've applied to many situations since. It wasn't until I had a moment to sit down and take time to fully understand the extent of what I was working with that I truly grew from this patient's ordeal. Thank you, all of you! Happy New Year.

Well written article. Thanks for sharing.

Wouldn't it be appropriate to call an actual. Code Blue in This situation vs just a rapid response or am I in the wrong on this?

Quote from jacqueline.dammBrainstormin' -they hang propofol drips in the ICU to keep a patient under sedation while intubated and on the vent.

Things change in an instant...or sometimes it is an imperfect storm. A great reminder to why the major issues can't be ignored and that advocacy and investigating IS a huge part and art of what we do...if no one else is checking, who will?

I know this is a side topic, but propofol can be placed in a bag by pharmacy if the mL/hr is a high rate where you have to change the bottle frequently. If it's put in a bag, it's only good for 6 hours vs the 12 hours from the glass bottle (I think those numbers are correct. We tend to use fentanyl and versed drips with or without vec depending on the situation). To to the original poster, it sounds like you did everything right! Thank you for sharing

Why would call a rapid response versus a code blue? You said the lab was checked for two days,who is responsible for making sure checking the C02 lab ( was the doctor supposed to order it, was the nurses supposed to call and ask the doctor to order it ). Was anyone written up or receive a verbal warning for this or was it nobody's fault? What could have been done differently in this situation to prevent it, if anything?When you hung those bags of bolus fluids , did you have an order or is this a protocol on your unit ?FYI : I don't have RN experience yet so I'm not sure what to expect in this type of situation.

great article,and too true ladyfree28 if no one else is checking, who will ? I read one of those sayings-a-day tear off calendar pages today, said "its takes many to deliberate but only one to take action" - well done you ! the patient will probably never know but its why we're nurses ....