Wednesday, September 23, 2015

Almost killed my patient (as a student!) and wished I had seen it!

I've been in the healthcare field for like 14 years - I've been a practical nurse for 5 years and I've been working in my hospital on my unit for 4+ years and I can say that I have not actually lost a patient on my watch (technically).

I've had a patient die BEFORE I come on, and AFTER I leave - and where the technicality lies is where once I had a pt died after my shift technically ended but before I was able to give report - so technically the pt died on my colleagues shift.

And pt''s who have actively tried to die on me I've managed to keep living long enough to be transfered to ICU.

Now as a student I had a pt during my last clinical time who had had a knee replacement surgery done - on a replacement that had become infected secondary to a tooth infection and therefore needed to be replaced (so the replaced knee was a replacement).

Well the pt lost quite a bit of blood during the surgery and then when they got to us had put out a bunch (say 700ish cc) in the last 8 hrs and when their Hgb was checked it was found to 8.1 = transfusion certainly needed! So it was our responsibility to set them up.

Here's a foreshadow - pt has a history of A-fib - but it's managed with meds now and pt's on Lovenox

So we put pt on telemetry and start the transfusion slowly - pt's never had a transfusion previously o we explained what reaction sort of symptoms we're anxious about - itchiness, difficulty breathing, hives, flank pain, fever, chest pain, etc...

We wait 15 min - pt says they're feeling the same way so we increase the transfusion slighly for another 15 min and still no change - so we increase it slightly again and my preceptor likes to stay with the pt throughout the transfusion (if and when possible of course!)  so 15 min later pt says that everything is peachy keen (A-ok) so it gets increased a bit more to be about 110cc/hr and we maintain it there until it's time for us to leave - when we left pt was perfect - napping in fact - feeling perfectly normal - including normal sinus rhythm with clear breath sounds and appropriate RR of 16!

So when we got back in the AM and find out that pt is no longer in the building I was shocked to say the least. I ask what happened and am told that nearing the end of the transfusion (say 45 min after we leave) the nurse informs us that pt went into A-fib then v-tach and they tried to cardiovert him by DEFIBRILATING him....

And it fails and they immediately send him to another hospital so that they could deal with this!

Man I wish I could have seen it - just last week (and the week previously) we were going through heart rhythms and that would have been PERFECT to use as a case study for school! Plus to see it up close and actually experience it myself as well as the cardioversion would have been quite the experience.

So ya, loving my site - wish we get more cool stuff happen. Time will tell - but at least I'm still on record for no deaths!

1 comment:

  1. Oh my goodness, we just learned about heart rhythms and I got to go to the ICU for clinicals yesterday. Let me tell you, I got to see almost every heart rhythm on one patient, we attempted cardioversion 3 times, waited an hour or two and then tried another 4-5 times but he would not get out of V tach. We started dialysis on him and I got to see a PICC placed for his dialysis. It was such an amazing day and G-d allowed everything that I was confused about in class on Friday to finally stick in my head yesterday. Praise the L-rd for His amazing ability to get us learning experiences. I am very sorry you got to miss all of the acute stuff with your patient though, that's a huge bummer. G-d will get you time to learn all of those things though!