Deja Vu
It happened again last night. I walked into a patient's room and the nurse was trying to get the patient onto a bedpan totally oblivious to the fact that her patient was blue with eyes rolled back in her head and couldn't be woken up. I said nothing and left the room for a few seconds to get a vital sign machine. I came back and checked the patient's oxygen saturation. It was in the forties. It should have been in the nineties.
I increased the patient's oxygen and started shaking her to try and wake her and get her to breathe. Her respirations consisted of an occasional gasping, snoring sound. It was only then that her nurse realized that her patient was in trouble. That is more than a little scary.
Once the nurse knew her patient was blue, she knew what needed to be done. The problem is that she couldn't assess lack of oxygen by herself. This time, unlike last week, I took over.
The patient was taken off the morphine pump and given narcan to reverse the effects of the morphine. She woke up and turned pink, but the only way to keep her properly oxygenated was with an oxygen mask turned all the way up. If she took the mask off, her O2 saturation dropped to the seventies.
It wasn't hard to get the doctors interested in her. They were all acutely aware that we lost a healthy patient last week, likely due to a morphine overdose. No one wanted to fool around with this patient, so she was transferred to a monitored bed where they could keep a closer eye on her.
I have no idea what is wrong with her. She had no chest pain or shortness of breath. Her tests were all fine, except for the blood gasses. There was no evidence of stroke or heart attack. She never got anything to eat after surgery except for sips of water, so aspiration was unlikely.
My hunch at the time was that she just needed more narcan to totally reverse the effects of the morphine. She only got a stingy dose. But if that had been the problem, by today, the morphine would have been out of her system, she would be fine and she would have been returned to us. Instead, she is still on a monitored bed. But, at least she is still alive. That is a much better result than last week.
Written by Melissa on 12:46 AM
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Melissa blogging from sunny Santa Clarita, Southern California, United States.
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6 Comments:
Good job stepping in and doing what needed to be done! :-)
It sounds like it would be hard to miss the obvious; that this patient wasn't breathing. I wonder why this is the second time that similar situations have happened. Why isn't the nurse noticing? Is it really as obvious as it sounds? Blue face, eyes rolled back?
I don't know how you can go to work and handle that kind of stuff on a daily basis. My heart goes out to you.
Two in a row sounds like more than a coincidence. Perhaps an equipment malfunction or a bad batch or morphine? I'm so glad you caught this one in time.
IL nurse, both of these situations involved nurses from other floors. They are not used to dealing with people on morphine pumps and so aren't attuned to the early sigs of hypoxia. But still, you would think that they would notice the late sigs, which should be totally obvious to anyone.
Mahala, at least these things keep me from getting bored.
Connie, we routinely overdose the patients. It is a fine line between getting the patient adequate pain relief and killing them. The lethal dose is different for every patient, so we use trial and error. The regular nurses on my floor watch the patients carefully and know, before it is too late, to ease off on the pain meds.
VIPs never get float nurses on our floor. It's a shame that they don't hire enough regular nurses so that no one has to get a float nurse.
i totally get you. these are events that will keep your adrenaline pumping, even if it is not your own patient.
That's true, but it's something I could easily do without.
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