Flooding And Smothering

Change of shift is the most dangerous time to be a patient. The nurses are all busy giving or getting report. That's why one of our patients ended up in the ICU the other night.

The patient came back from surgery at 11 pm, the beginning of the change of shift. Her IV was dripping by gravity upon arrival. Normally, we switch it over to a pump so that we can regulate the rate better, but we were out of pumps. One was ordered, but no one had time to go down to the basement to pick it up. We have a narrow window of time for report. If it doesn't happen within that window, than that means overtime for the outgoing nurses. There is no greater sin.

So, while the nurses were busy with report, this extremely elderly lady was left alone. As so often happens, the IV got away from us and an entire liter of fluid got rapidly dumped into her veins. Had she been young and healthy, this wouldn't have been a problem, but for her, it was nearly deadly. Her heart could not beat hard enough to cope with the additional fluid and the fluid backed up into her lungs.

Soon she was gurgling and struggling to breathe. That's why she had an unexpected trip to the ICU. She is doing better now. No, she wasn't my patient, thank goodness.

My patient was nearly smothered. She was in a chronic vegetative state due to advanced Alzheimers and needed frequent turning so that her pressure ulcers wouldn't get any worse. She was paralyzed and was completely contracted in a ball. I left her on her side, propped up on pillows. When I checked on her later, she was lying face down in her pillow. I thought for sure that she had smothered to death, but she was still breathing. What a relief.

I'm not sure about the wisdom of making a person in a chronic vegetative state a full code and doing whatever is possible to keep her going as long as possible, but it wasn't my call and I certainly didn't want to smother her. What I can't figure out is how she got face down. She was in a little ball, did she just roll?