Hey guys. I have a really sad case tonight, and I need to get some of it out.

Got an overdose patient from the ER, on the vent, we're not positive what she overdosed on. Lasix and something else. When I got her, she had only a slight corneal reflex in one eye, no response to pain, slight doll's eyes present. Mottled skin, had a hard time getting a O2 sat on her. Had to bolus her to get her pressure up.

When she came into the ER her blood sugar was 16...who knows how long it was that low. I checked it, it was 5. It took a total of 5 amps of D50 over the course of an 1 1/2 hours to finally get her to 73. Whew. We'll see what it is next time I check it. Who knows what those drugs did to her pancreas.

Her family is so distraught. They keep asking her to wake up. She's in her 40s. She has kids. It's so sad.

The big question is how much brain activity she has. She is breathing 15, and the vent is set at 14, so that's a good thing. But I'm afraid she may never "wake up" and recognize the faces of her dear family.

I feel like crying just posting this, so I better sign off and get my emotions under control so that I can take care of this lady. Pray for her, and even more for her family.

~Anne~

Well, last week I had my first truly crashing pt since orientation. Here's what happened. And keep in mind that there is no senior nurse on our unit this night...it was me (graduated in dec), two other new nurses, a float nurse, and an older nurse who does NOT do well in crisis situations.

Got report on a pt coming from the ER who had come in with complaint of diarrhea, weakness, etc., and who went into acute renal failure and coded in the ER. Ok, he's coming to me. His K+ was like 6.0 and his creatinine was 11.8. WAY high.

He gets to the unit, right way he's hypotensive in the 70s. Started a bolus. Didn't work. Started dopamine. Titrated dopamine to the max within 30 minutes with no affect. Stopped the dopamine, started Levophed. Titrated the levo up pretty fast. Finally, I'm getting a pressure that's at least 80s systolic.

The cardiologist was on the unit and he wanted to go ahead a float a swan through the central line that the guy already had. The cardiologist is new to our hospital, and it was his first time floating a swan here, and it was my first time helping a physician float a swan. GREAT. Love the combo. Soooo...I was trying to get all the supplies together and I went next door to get a sheath kit. When I came back, I could see all the way from the end of the unit that my patient was coding. !!!!!!!!!!!!! I took off running.

Well, no kidding, he had gone into V-tach, v-fib, then he didn't have a pulse. We shocked, did CPR, pushed epinephrine, atropine, and amniodarone. After 5 shocks and all those meds, we finally got him back. Talk about an experience. There were about 10 health personel in the room and 20 outside of it, observing.

Then I started Dobutamine and a Lidocaine gtt. THEN we finally got the swan floated in. But not after I accidentally switched the proximal and the distal ports when I hooked them up. The cardiologist was like..."somethings not right here, all our pressures are off," and I finally noticed my mistake.

At this point it was about 1 am. The nephrologist came and put in a line for dialysis, and we finally got the pt started on dialysis, which was what he really needed. All of his out-of-wack electrolytes that were built up in his body were causing his heart to go into arrest.

The whole time I was titrating the levophed to keep the pt's pressure up. Whew.

At the end of the shift, he was still with us. In fact, he's still alive today, doing much better, might get an AICD. But wow, he almost didn't make it.

Even though the whole night was super stressful, by the grace of God I was able to keep my head on straight, and it was actually kind of fun. And I could come away from the night knowing I helped save a life. That is such a strange realization. As a nurse, it's one you almost downplay and take for granted sometimes...I find myself thinking, "Well, I just did my job...and if I hadn't been there, someone else would have done it." Which is true. But still, it's pretty cool to be involved.

~A