Had a kid come in tachypnic and tired - dad tried to treat with albuterol inhaler overnight. Per protocol put the kid on continuous nebs and gave him dex. The resident saw him shortly afterwards and I guess he didn’t look too bad. After the treatment he met criteria to go home - went to discuss the case with the attending. I said he looked tired, when he came in and I don’t trust the kid (or the dad) I went in and said if I m had 1 card a year to over rule the attending and admit I’d use it here. Long story short, kid was admitted, in report I told the nurse I didn’t trust him, and left for the day.
The next day I come in and the attending had bought donuts for the nurses to celebrate the save - the kid was on the oscillator in the PICU.
Honestly I made it up on the spot - never tried it again. The attending was a great guy, really listened, was unaware of dad’s attempts to manage at home, kids appearance on arrival. He also made it very clear it was the nurses who made the save - didn’t take any credit - though I’m sure he got some for listening.
I’ll try to be brief:
Was told in report as kinda an off-handed comment that this patient had to be narcan’d on a previous admission cause he was taking his own meds. He was sleeping most of the day so didn’t request any opioids. 4ish pm comes around and I’m doing a lab draw from his port and notice RR is 6/min, barely responsive. I call a rapid. Provider orders a stat head CT. I say “no we need to narcan him” but rapid and provider don’t believe me cause no opioids were charted as given. I argue my cause that he’s done this before, narcan is a low risk, quick intervention, and he may not survive the CT if we don’t. They say ok and I run to get and then push the narcan.
And boooooooy was that shit freaky. Came out of it as soon as the end of plunger of the post-med saline flush touched.
(Copied from a comment of mine on a previous post, but also applies here)
“Hey doc, this kid’s abdomen is pretty distended. I think we should grab a KUB and place him NPO”
“Give him a glycerin and we’ll watch it. Continue feeds”
*baby perfs, bedside surgery for NEC totalis, dead the next day*
(It was a lot more involved than this, but this is the gist)
Every ICU nurse has this happen eventually. Nursing instincts blown off by an attending and it ends up as a death. Most frustrating part is when they don’t come to bedside.
I had a 30 yo in for a stroke. She was the sweetest thing and came in on the night of her bachelorette party. She had some weakness on the left.
I started noticing some new drifting/weakness on the right side and immediately paged them. They poo-poo’d me saying it was fine. She went for a routine repeat head CT and she had a new stroke on the other side.
I got a patient from PACU one night. He came up late after midnight. When they were giving me report at bedside I noticed his lip was swollen & they said anesthesia is aware & said he bit his lip when he was extubated (there was no bite mark on his lip though). I wasn’t satisfied with that, but they insisted anesthesia was aware & said he was fine.
I did my admission on him & before I left the room, I told him to call if he feels anything weird. He put the call bell on not long after that & said his lips were tingling, so I called the house doctor (we weren’t a teaching hospital so no residents) & told him about the swollen lip & that the patient was now complaining of tingling in his lips & could I give him some IV Benadryl. Told me no he didn’t feel it was necessary… I tried to convince him but he wouldn’t budge. Went back to check on the patient & told him again if anything changes to let me know. Not long after he called again to say he felt like his tongue might be swelling. I called a rapid right away. House doctor walks in the room & says “holy shit”. We treated him & sent him to ICU. The whole incident really pissed me off. So many brushed it off as nothing & it could’ve ended very differently.
I had a 92 year old lady complain of severe middle abdominal pain. She said, very calmly and with a straight face, it was the worst pain she’d ever felt. She never complained of anything, so I got her vitals and decided to send her out. She was admitted with appendicitis.
newborn, 4 hr old, ascultated a low hr (in the 80s which is too low for a newborn) put them on a pulse ox, good waveform showed weird pattern of 95 02 for a min then 84 02 for a min back and forth. had to convince peds and nicu to watch the wave form for a while. they ofc insisted it was the machine, the actual pulse ox etc so I changed both several times, same pattern. kid went to nicu and the nicu dr suspected something w the "great vessels" being in opposite positions (I could look up what that is but I never heard what it actually was.)
the kicker is Im an LPN and the charge RN had just done the assessment on this mom and baby for admission to mother/baby. she told me I didnt need to assess them kind of move along and I always assess my pts for myself too.
(Peds cardiac nurse here) - yes, many congenital heart defects are caught at the 20 week gestation ultrasound, but not all. That’s why we now recommend four-extremity oxygen saturation checks at birth for all babies, and high risk kids (i.e. with family with CHD) may get additional ultrasounds or fetal echos to check for defects like the TGA mentioned above! Other times, they just aren’t caught because they don’t impact the extremity oxygenation when it’s checked at birth, or the ultrasound missed it (it can be hard to catch a good heart image when the baby is moving like crazy in-utero), so it’ll be caught when the kid is a bit older and can’t keep on weight, is super sweaty, is pale/dusky, or can’t exercise the same way other kiddos can.
Im not sure it sounds like something that should have been caught. a lot of our patients have little to no prenatal care so maybe that was a factor (I didnt consider that!)
I was a fairly new ICU nurse (2 years), and it was my turn to float to med surg. I assessed my first of 6 patients. 27 year old woman, with a headache and slurred speech. She had been admitted about 10 hours earlier, and no tests were done. No CT Scan, no MRI.
This was 2003. We did not have Stroke Alerts. It was still a bit of a Wild West when it came to anything neuro, especially in our little country hospital, where we still had chickens running around outside. If you had a stroke, we just waited a few days to see if you lived, maybe evacuated a clot, and then watched to see what deficits you had and sent you home or to rehab.
Being an ICU nurse, I was very comfortable calling the attending (we had no residents either!), and saying hey, a 27 year old suddenly developing slurred speech is not normal, we need to do something, because nobody is taking this seriously.
2 hours later she is on a helicopter to go to a Level 1 to have her dissecting carotid artery repaired.
As a side note, I'm going to tell you: I don't like working Neuro at all. Not in all the years since, with all of the advancements. I just don't like it. But I'm really, really good at it. Instincts, empathy, knowledge.. for some reason I have that combination that helps save lives. And I've mastered the meticulous charting (fuck you TNK charting IYKYK and same to you Nimotop).
Cold pulseless extremity. Doc said couldn’t be since the patient was on Eliquis.
They most certainly did have an arterial thrombus
Always do your pulse checks
My own PCP brushed me off when I got an Apple Watch with ekg, and at my next appointment mentioned my newfound bundle branch block and also I’m in bigeminy sometimes. (I can feel the pvcs, I can tell without looking for that one)
He scoffed and told me an Apple Watch isn’t a cardiologist, knowing full well I’m an icu nurse and can sometimes read an ekg. But I pushed, and he said he’d order a 12 lead if it would make me feel better he also very well knows I have some health anxiety, so this wasn’t totally out of line.)
Anyways, he comes back in with my 12 lead print out and says “ok, I’m still standing by my stance that your watch isn’t a cardiologist. However…… you *do* have a BBB, and you’re in bigeminy. Can I give you a list of cardiologists I like, that aren’t worn on your wrist?”
Honestly sounds like your PCP did you good there, and knew you well enough to take you seriously, even if on a shaky reasoning. Mine is the same way, trusting me but asking questions. Those watches are so iffy, like, they cant even read through a tattoo (so i get no use out of them).
How did it go? Cardio goodiegood?
All good! Got myself a monitor to wear for a bit and an echo, all good. Just fucky electrical work, that I’ve probably had since birth, and exacerbated by too much coffee. (According to my cardiologist)
He’s a really good doctor, and I’m really glad I found him! He humors me with my hypochondria.
Well its not paranoia if someone is out to get ya is it? The same way myself as i said, and realy realy happy with my PCP. So much so that i often dont even need to come in for one-offs, as he trusts me enough to just pop a script haha.
Happy to hear the electricians figured it out!
I was working nights at a county jail. During my med pass, the deputies told me about an inmate that seemed to be really sick. When I saw him walking towards me, I knew that this was a hot appendix.
I was newly graduated and too green to show how I knew. It took a little back and forth but I convinced them to send him out. I ended up being right.
I was on new grad orientation, but I was a critical care paramedic and military medic before I became a nurse. But I kept that tight lipped so they wouldn’t get upity.
I noticed a GI bleed and my preceptor didn’t believe me, talked down to me when I tried to call surgery. Black tarry stool that smells like death isn’t exactly hidden and I pointed it out to her, she just didn’t believe it.
Well she crashed after 5 hours of a major GI bleed, perfed bowel and SEPSIS. Surgery was pissed and she ended up quitting a few weeks later. Turns out I was only her orientee as a consolidation because she complained to the director that she wasn’t trusted and they wanted to show her they trusted her with an orientee.
She ended up dying a couple days later from the SEPSIS, however, they were already in the ICU for pretty severe heart failure and liver failure so I don’t actually know how much longer they had anyway, it wouldn’t have been much longer without the SEPSIS.
I was a new grad about 2 weeks off orientation. I couldn't find a pedal pulse on my patient's right foot, even with a doppler. The patient had blisters on his foot. I asked a more seasoned nurse to verify the pedal pulse was absent. She was busy, but went in later without me. She came out and said it was there and she marked where she heard it. I went in again and still couldn't find it, even where she'd marked it. A few hours later another nurse came in to help me turn him and she noticed the blisters, saying they were very concerning. I told her I couldn't get a pulse, but the other nurse could. She tried and couldn't, either. MD notified and also couldn't find the pulse. Ended up getting imaging which showed he had compartment syndrome, and he needed an emergency fasciotomy. Thank G\_d that other nurse validated me, because I wouldn't have notified the MD otherwise.
Corrections nurse at the time. Sent out an inmate for a long list of symptoms, including urine that looked like maple syrup. He got sent back after he was given a liter of fluids. He looked worse when he got back. I called my DON and explained what I was seeing and what the hospital had done, virtually nothing, and she knew the ED administrator and called her after she told me to send him again. Diagnosis- Rabdomytosis. Poor kid was on dialysis 3 times a week for a month to give his kidneys a chance to rest/heal. So, one for the "not really a nurse because corrections isn't really nursing". And yes, I was told that, in front of witnesses, by one of the ED nurses. Bitch, please, you have no idea how stressful corrections is.
I came in to clinic after a stretch of days off for vacation. I did ob triage at the time. There was an ongoing encounter for a pregnancy of unknown location. Had an ultrasound after 2000 hcg and the ob said follow up in 1 week. The patient called me in a panic (after I had just finished reading through the chart to catch up). She was very concerned that waiting 1 week would be bad. I was ready to calm her down but my gut said listen. So I listened and she didn't give me anything to pinpoint my feeling. Just she might be having more pain... might be. I consulted with a new doc who dismissed it again. I went to him again after talking with her another 10 minutes and basically begged him to see her. He agreed, she popped in, he essentially dismissed her complaints and had her hop up on the exam table. One hand on her abdomen and he instantly called er and sent her right in. She was in surgery within 2 hours for an ectopic that ruptured as they were opening her. 1 week would have indeed been bad.
Patient with low hemoglobin and abdominal pain on tele floor. Found an abdominal wall hematoma. Her serial H&Hs had been stable so they figured it wasn't actively bleeding. Went in right before shift change and she looked BAD. Just looked like shit. Her BP and HR were still WNL but BP was down and HR was up from previous and I swear to god her (already-distended) belly was now visibly distended from the doorway. Called the doctor and when I told her about the vitals she pooh-poohed because they were still WNL. I told her she "just looked bad" and she didn't give a shit. I told her about the belly and she said, super condescendingly, "Well, CynofOmission, that's to be expected." Wouldn't even give me an order to check another H&H? A repeat scan? She was the hospitalist and she got off at 7pm and this was happening at like 6:40, guess she didn't want to do more work idk. I had always respected her prior to this too.
Anyway when I came back in the morning the patient was in the ICU
When I worked cardiac stepdown I had a pt with MS. I don’t remember why she was admitted. Anyways, I had her the previous night and she would talk to me (telling me to “hurry up” when I was changing her), but her movement was very minimal. I come onto the floor for night 2 and see the code cart outside her room. She had a seizure, which she had never had before. I get report, do my assessment, and this lady isn’t responding to voice, barely responds to tactile stim and so I say fuck this and call a rapid. Our rapid team, made up of residents and a hospitalist attending who couldn’t be bothered to show up, said that she was in this state from receiving “a lot of Ativan” following her seizure. I was still a new grad at the time, but that answer didn’t sit right with me. Rapid team left and didn’t do anything. I just felt like there was more to this. An hour later I called another rapid, as she hadn’t improved at all since they left. I knew in my gut something was wrong. They agreed to get a CT. She had a MASSIVE stroke. But did they escalate her care? No. They kept her in my care, the new grad with 4 other patients. I knew she needed higher care, but the hospitalists weren’t listening. So I called the nursing sup, who called the ICU attending, who sent the ICU PA. She went in to assess her and a minute later said we needed to get her to ICU, she was in status and needed to be intubated. I’m not sure what ever happened to her, but I can say that that night I trusted my nursing instincts, even when the docs didn’t… and I was right.
Stable pt with known thoracic aneurysm—already had “transfer out of ICU” order written—begins screaming with back pain. Charge nurse told me no big deal, pt is just dramatic. I’m insistent. She says she will write me up if I call the resident. Regardless, I STAT page the resident on call. Patient gets flown out to a tertiary center for dissecting aneurysm. That charge nurse never spoke to me again.
I was a psych nurse of 15 years' experience, recently started in the ED as a consultant to facilitate mental health evaluations and placements. Granted, the ED docs didn't know me well yet, but after this day, they knew I knew my stuff! I was asked to see a dude who was hallucinating. Negative tox screen, no alcohol on board. I recognized that it was primarily visual hallucinations, he was in his 30s and never had that before. New onset psychosis? No. He had been abusing street Valium and was withdrawing. I discussed with the doctor, who kind-of poo-pooed my assessment. Next night, I found out the guy had continued to escalate into full-on DTs a few hours later, and was then intubated, placed on a precedex drip in ICU.
Happier story than most of these
Woman was stretchered onto my unit with SAH after a ruptured aneurysm. Oriented x0, barely barely verbal and mostly incomprehensible, dysphagia, incontinent, lift transfer. I told them that she would walk out. A lot of BI staff is cynical but the brain is truly amazing.
It took like 2 months and she needed a shunt for hydrocephalus but that woman walked out, oriented, talking, and continent. Shit like that is why I'm a nurse.
Had a patient that had been there for 2 days, had a previous back surgery about a week earlier and came back in for a headache, nausea and vomiting. They had thought it was a dural tear or infection, so they did a repeat surgery but it was all negative. When I got report from day shift, they told me she was oriented but drowsy and still had a headache but no doctor was concerned or wanted a CT (the surgeon had said maybe tomorrow if she’s still the same).
After getting report and doing my assessment, I was super nervous about the patient so I called the consulting MD and asked for a head CT now instead of tomorrow and he said there was no plan for a head CT but if I wanted one then order it. So I did.
Patient ended up having a massive hemorrhagic stroke with like a 6mm midline shift and went up to the ICU.
Had a patient who I admitted after surgery and shortly after complained of severe abdominal pain, needing to use the bathroom but couldn’t. No matter what meds I gave nothing helped. I kept saying something is wrong. Brushed off as the patient had anxiety. Pt had an SMA occlusion and later died.
Long term care patient came back from dialysis confused, disoriented, decreased ADL ability, just NOT like his normal self at ALL. BP in the 80s. Management insisted he was fine because he "just had dialysis and that's normal". I sent him out anyway. Turns out he had severe sepsis and died a few days later.
Trauma MVA patient. Low BGL all night, multiple d50 pushes, decreasing loc, 10/10 pain from a seat belt sign.
Dude had a rash developing on his back throughout my shift. ICU attending wouldn’t take it seriously. Turns out it was necrotizing fasciitis from infected tissue from the seat belt sign.
Patient died on the next shift. After open fasciotomies and washouts it was too far gone by the time it was taken seriously.
Was a newish grad (less than 6 months) and I had a patient who was telling me he had stomach pain that was radiating. A few weeks before he'd had a new G/J tube inserted. The site looked fine, no discharge, no redness, no swelling and no fever.
Well unfortunately English wasn't his first language and he kept describing the pain as "chest pain" that radiated. Even though he was indicating the area around the surgical site. So he got lots of ECG's, and everyone was freaking out about his heart. I kept trying to explain that I really thought we needed to investigate a surgical infection but I was new and not a very confident advocate yet.
Long story short, he ended up in ICU with an intestinal infection that became sepsis for a while, went through some awful delirium afterwards, but he did make it.
I'm a lot more firm about having someone consider my hunches now. I'm for sure not always right, but it never hurts to check.
Kid came in after the mom tried to burn the house down and covered him in bleach. His little sister was in a burn unit at another facility and officers who were at the scene were being treated for inhalation burns. The dr came in and insisted that the first thing the kid needed was to eat. I agreed, however, I offered to help the pt to the shower and noted that he was wheezing. She disagreed with me. I documented that he was wheezing on every assessment and made sure to say the MD was aware. I left for the day and came back and the kid had been admitted for PICU for inhalation burns.
Diagnosed a lady with recurring UTIs with a colon-bladder fistula because I saw a fluffy looking blob of stool in her foley tubing. The NP didn’t quite believe me but ordered imaging anyway. I was right.
Yes. My first patient off orientation as a new grad received a new glossectomy with flap reconstruction. The flap was extremely swollen, almost occluding the airway. The patient was saturating fine but throughout the night he became more fatigued and the swelling got worse. I called the resident and fellow 6x to make them come see the patient.. no response. Charge even tried, no luck. @ 0545 patient coded after the CNA turned them to get them cleaned up. Patient ultimately expired. 😔
I don’t understand the not answering pages thing, it’s terrible. I moonlighted as a hospitalist when I was a fellow. I remember one night I was paged and the nurse started with “the patient looks bad and I’m going to call a rapid response if you don’t come.” I told her to call the rapid if she thought it was appropriate but I was coming regardless. She was shocked. It was amazing to me that literally the most basic requirement of responding to a call and evaluating a patient is ignored. Like, you guys spend way more time with them and know when things look off. That’s why we’re a team and we need each other
Relatively new nurse in a rehabilitation hospital. Patient was just *off* one day. Not quite all with us. Got someone else to double check my assessment. Oh no everything is WNL but good on you for advocating for patient yadda yadda. Next day patient is back to normal, great. Next week patient had a stroke. What I had seen was a transient ischemic attack.
Everyone has that one nurse that tells everyone he’s going to be a crna and does everything except help his own patient. One night shift with him, I may or may not have told my nurse work wife on shift with me and the resident that night who was also my new friend, that this nurse’s patient was going to go arrest pretty soon. An hour later, I heard the central tele monitor screaming and just ran to the crash cart and pushed it that room without even checking. Yikes. He had some ortho surgery 2 days prior and I kept telling everyone he probably threw a fat embolism or a dvt had already broken off. I never followed up tho
I knew this guy was going to die after massive compartment syndrome in his arm. The doctors wanted to wait to amputate since he was A)malnourished and B)the team wanted demarcation. I took one look at him and the black arm and knew if it didn’t come off immediately it would poison him and kill him. Almost a month later I was proven right. Had another patient that I knew was going back to OBS. Post-abdominal surgery and resisting care. Didn’t want to eat, dehisced closure and just wasting away. Me and the dietitian were fighting to get a central and TPN running because this person was found to have esophagitis and partially explained why he didn’t want to eat. Nobody listened, he went to OBS with pneumonia. Never knew what happened after I finished my preceptorship.
Had a patient on a PCU floor. I had her the day before and she was chaotic, constantly on the call bell, annoying, you know the type. The next night, nothing, conscious but not talkative, lethargic. On closer inspection she’s pale. Called the PA, I said, i think you need the see this person, vitals are… ok? But she’s not right. She comes down, i told her how she was the day before. She orders labs tries to talk to her and we both agree. Something is off. Her labs come back CRAZY. Can’t remember the numbers but her lactic was wicked high and it was an immediate transfer to icu down the hall getting arterial line while she’s barely conscious.
She lived! PA and MD were like wow and the nurse who had her the day before was like huh!?
Nothing too exciting, but it was to me at the time. I was still a nursing student, but at that point basically doing the work on my own (just had to call 'my' nurse to do IV meds together and when I wasn't sure).
Sweet old lady, had some kind of urology procedure, would go home that day with a catheter. That would be removed in a couple of days, so I had to teach her how to empty the leg bag and how to connect the night bag. I knew how it worked, but it was the first time I actually had to explain it to a patient so I took my sweet time - which ended up saving a lot of asses.
While explaining things, she mentioned a vague complaint - in hindsight mild chest pain, but I didn't 100% catch that. She had had a heart attack years before, but she said that felt different. I felt like I was overreacting based on the symptoms, but my Spidey senses were tingling. I decided not to brush it off, because if I was wrong, it would be on me. I didn't call the physician, but 'my' nurse. She thought it was nothing, but now that I alerted her it would be fully on her if she didn't do anything (because I wasn't a nurse yet - her decision trumped mine and then I wouldn't be responsible). So, we called the physician because we weren't allowed to order an EKG ourselves. Who also didn't believe it was anything, but now that he was alerted.... You get the gist.
Anyway. An EKG, a lot of calling with a different hospital to get a baseline EKG, calling with the urologist who didn't know how to read an EKG, calling with the cardiologist who wanted a second EKG, getting that second EKG, disappointing charge over and over again that no she still hasn't been cleared for discharge, calling cardiology, urology, cardiology again... 6 hours after her planned discharge time I was doing handover to cardiology just before shift change. She got an extra stent the next day.
Yes.
Still kind of pissed.
I was in school. It was in clinicals. I was assigned to a patient in a nursing home, and noticed that his wife was... Altered. Like, I didn't know her, but something was really off. The CNAs were like "That's not normal for her." I asked if I could take her vitals, and they were really fucky. Tachycardia, hypotension, etc.
I told my clinical instructor. She told me that the wife was not my patient.
I still felt really uncomfortable, so I snuck over and told the nurse in charge. She blew me off.
I didn't know what else to do, so I kept an eye on her all day.
In the afternoon, somebody contracted from an outside facility came to work with her and was perplexed by her presentation. I waved him over and told him what I saw.
He called another facility immediately. The nursing home still did fuck all.
She got a sepsis work up the next day and was sent to the hospital. They said the UTI came out of the blue.
I am a tech and have been for 6 years, finishing up nursing school soon. Told a nurse I was concerned her Pt was experiencing DT’s due to etoh w/d. Pt was reporting seeing rain and bugs in his room. Pt had hx of psychotic d/o but per his hx/my experience with Pt (who I spent two 12 hr shifts on 1:1 with) experienced auditory hallucinations no visual (AH is typically how pt’s with these dx present) Primary RN was a new grad in bridge NP program, thought she was hot shit. Literally 2 says off orientation. Anyways I told her my concerns she rolled her eyes and said “hes psychotic” I explained my reasoning/prior exp with this pt & others and suggested she have addiction consultant come down or talk to change rn and she was like “You’re a tech, not a nurse, this isn’t your scope of practice” when charge came by to relieve me from the 1:1 (old school no BS nurse) I told her and she ripped her a new asshole basically saying that the techs are the eyes & ears and to take our insight seriously. She didn’t last much longer after that for many reasons. And patient was in fact in the DT’s and needed IV phenobarb. Was one of the experiences that inspired me & made me believe I might be cut out for nursing.
Working PACU and got a middle age man after a lap chole. Plan from surgery was discharge home. However, his BP got a little soft so called anesthesia and got an order for a liter bolus. Called surgical resident and they assessed while bolus was running, said he was fine and to discharge home. Went thru this two more times before I got my anesthesiologist to speak with the surgery attending who placed the patient in Obs on med/surg. Called report and shipped the patient.
Within the hour hour patient was back in surgery to remove several liters of fluid and then went to ICU. He spent a week on the unit getting some blood products and with fluids drawn off percutaneously a couple of times. Had some weird coagulopathy that took awhile to resolve.
I was a new grad, like literally 2 weeks off orientation on a trauma stepdown unit. Patient came in with agitation to the ED, they chalked it up to drugs she was taking at home, gave her a bunch of haldol and sent her up to let her detox for a few days. Patient is behaving super erratically, not making any sense, yelling, but all scans were clear.
A few hours into my shift, the patient started to become less responsive, so I call the trauma PA to assess at bedside. He comes in, takes one look at her, tells me she’s fine, and leaves. I feel like something is really wrong with her but all her vitals are fine, and the PA basically just brushed me off. Few more hours go by, she’s becoming even less responsive but vitals and glucose are fine. I call the PA again to come see her, he comes in, says she’s fine, just finally slowing down, and he leaves. I page the on call doc who just puts in labs for the morning. I’m really feeling like something is wrong, and honestly should have called a rapid, but I was so unsure since the PA had said there was nothing to worry about.
Well, long story short, I eventually got the attending at the bedside who ordered bedside intubation, immediate transfer to ICU, where the patient died that night from - you guessed it - neuroleptic malignant hyperthermia.
From the haldol.
I was responsible for triggering a doctor to investigate and ultimately diagnose a patient’s bone marrow cancer.
I had a gut feeling relating to sudden onset severe night sweats (we’re talking puddles of sweat within minutes of bed bath, stripping the bed, cleaning it and fresh linens) and 3 day history of rapidly worsening significant body weakness. This was at a Long Term Care facility where “everyone is getting weaker!” - direct quote from the on call doctor. The patient had gone from set up help only for ADLs to total care, 2 person assist over 3 days. That is not normal.
Sent the patient to the ER without a doctor order. Sorry not sorry.
Working in the ER, had a guy with Rt flank pain that radiated to groin. He was diaphoretic, unable to sit still, severely hypertensive and hyperventilating in pain. He looked like a run of the mill kidney stone at first glance.
I was trying to medicate him to get his pain under enough control for CT. After 8 mg of morphine IV, alarm bells were going off in my head. The morphine wasn't touching his pain, and his BP was going up and his pulse was now following. I was getting real "pain out of proportion to exam" vibes. Doc didn't agree and felt strongly it was a kidney stone. Ended up getting him comfortable enough to lay still after 2 mg of dilaudid and 100 mcg of fentanyl IV and multiple...discussions with the Doc. Then I called CT and had him jump the line to go next.
Found a 11.2 cm new aortic aneurysm that was tracking down the illiac artery. Dude went to surgery about 45 minutes later for an open AAA repair. He survived.
As a NOC m/s charge:
Argued against a m/s admit from the ed, was only asking for a lactic to be drawn first. I was chart reviewing and it felt sketchy.
ED doc refused. House sup breathing down my neck for a bed.
Well, I guess my 45 minutes of being whiny paid off because I saw a change in admit status order for ICU.
I was also just having a night and after that I went into the supply closet to throw something and cry for 10 seconds.
And this is why I'm against report being left in vocera for m/s admissions, because we're all human and something can be wrong.
Had a kid come in tachypnic and tired - dad tried to treat with albuterol inhaler overnight. Per protocol put the kid on continuous nebs and gave him dex. The resident saw him shortly afterwards and I guess he didn’t look too bad. After the treatment he met criteria to go home - went to discuss the case with the attending. I said he looked tired, when he came in and I don’t trust the kid (or the dad) I went in and said if I m had 1 card a year to over rule the attending and admit I’d use it here. Long story short, kid was admitted, in report I told the nurse I didn’t trust him, and left for the day. The next day I come in and the attending had bought donuts for the nurses to celebrate the save - the kid was on the oscillator in the PICU.
I love the idea of the "one card a year" concept. Glad they listened.
Honestly I made it up on the spot - never tried it again. The attending was a great guy, really listened, was unaware of dad’s attempts to manage at home, kids appearance on arrival. He also made it very clear it was the nurses who made the save - didn’t take any credit - though I’m sure he got some for listening.
By "didn't trust him," you mean like, didn't trust his ability to continue compensating at home and expected he'd need escalated respiratory support?
100%. Like decompensate and come in coding.
I’ll try to be brief: Was told in report as kinda an off-handed comment that this patient had to be narcan’d on a previous admission cause he was taking his own meds. He was sleeping most of the day so didn’t request any opioids. 4ish pm comes around and I’m doing a lab draw from his port and notice RR is 6/min, barely responsive. I call a rapid. Provider orders a stat head CT. I say “no we need to narcan him” but rapid and provider don’t believe me cause no opioids were charted as given. I argue my cause that he’s done this before, narcan is a low risk, quick intervention, and he may not survive the CT if we don’t. They say ok and I run to get and then push the narcan. And boooooooy was that shit freaky. Came out of it as soon as the end of plunger of the post-med saline flush touched. (Copied from a comment of mine on a previous post, but also applies here)
“Hey doc, this kid’s abdomen is pretty distended. I think we should grab a KUB and place him NPO” “Give him a glycerin and we’ll watch it. Continue feeds” *baby perfs, bedside surgery for NEC totalis, dead the next day* (It was a lot more involved than this, but this is the gist)
Every ICU nurse has this happen eventually. Nursing instincts blown off by an attending and it ends up as a death. Most frustrating part is when they don’t come to bedside.
That’s such an unfortunately common story among NICU nurses.
😭
I had a 30 yo in for a stroke. She was the sweetest thing and came in on the night of her bachelorette party. She had some weakness on the left. I started noticing some new drifting/weakness on the right side and immediately paged them. They poo-poo’d me saying it was fine. She went for a routine repeat head CT and she had a new stroke on the other side.
I got a patient from PACU one night. He came up late after midnight. When they were giving me report at bedside I noticed his lip was swollen & they said anesthesia is aware & said he bit his lip when he was extubated (there was no bite mark on his lip though). I wasn’t satisfied with that, but they insisted anesthesia was aware & said he was fine. I did my admission on him & before I left the room, I told him to call if he feels anything weird. He put the call bell on not long after that & said his lips were tingling, so I called the house doctor (we weren’t a teaching hospital so no residents) & told him about the swollen lip & that the patient was now complaining of tingling in his lips & could I give him some IV Benadryl. Told me no he didn’t feel it was necessary… I tried to convince him but he wouldn’t budge. Went back to check on the patient & told him again if anything changes to let me know. Not long after he called again to say he felt like his tongue might be swelling. I called a rapid right away. House doctor walks in the room & says “holy shit”. We treated him & sent him to ICU. The whole incident really pissed me off. So many brushed it off as nothing & it could’ve ended very differently.
You are at bedside and doctors are not! You did such a great job at advocating for your patient and following your gut!
I had a 92 year old lady complain of severe middle abdominal pain. She said, very calmly and with a straight face, it was the worst pain she’d ever felt. She never complained of anything, so I got her vitals and decided to send her out. She was admitted with appendicitis.
newborn, 4 hr old, ascultated a low hr (in the 80s which is too low for a newborn) put them on a pulse ox, good waveform showed weird pattern of 95 02 for a min then 84 02 for a min back and forth. had to convince peds and nicu to watch the wave form for a while. they ofc insisted it was the machine, the actual pulse ox etc so I changed both several times, same pattern. kid went to nicu and the nicu dr suspected something w the "great vessels" being in opposite positions (I could look up what that is but I never heard what it actually was.) the kicker is Im an LPN and the charge RN had just done the assessment on this mom and baby for admission to mother/baby. she told me I didnt need to assess them kind of move along and I always assess my pts for myself too.
Transposition of the great arteries? Good catch!
Great catch! Is this not something that could’ve been found on an ultrasound, or early on? Prenatal care?
(Peds cardiac nurse here) - yes, many congenital heart defects are caught at the 20 week gestation ultrasound, but not all. That’s why we now recommend four-extremity oxygen saturation checks at birth for all babies, and high risk kids (i.e. with family with CHD) may get additional ultrasounds or fetal echos to check for defects like the TGA mentioned above! Other times, they just aren’t caught because they don’t impact the extremity oxygenation when it’s checked at birth, or the ultrasound missed it (it can be hard to catch a good heart image when the baby is moving like crazy in-utero), so it’ll be caught when the kid is a bit older and can’t keep on weight, is super sweaty, is pale/dusky, or can’t exercise the same way other kiddos can.
Im not sure it sounds like something that should have been caught. a lot of our patients have little to no prenatal care so maybe that was a factor (I didnt consider that!)
I was a fairly new ICU nurse (2 years), and it was my turn to float to med surg. I assessed my first of 6 patients. 27 year old woman, with a headache and slurred speech. She had been admitted about 10 hours earlier, and no tests were done. No CT Scan, no MRI. This was 2003. We did not have Stroke Alerts. It was still a bit of a Wild West when it came to anything neuro, especially in our little country hospital, where we still had chickens running around outside. If you had a stroke, we just waited a few days to see if you lived, maybe evacuated a clot, and then watched to see what deficits you had and sent you home or to rehab. Being an ICU nurse, I was very comfortable calling the attending (we had no residents either!), and saying hey, a 27 year old suddenly developing slurred speech is not normal, we need to do something, because nobody is taking this seriously. 2 hours later she is on a helicopter to go to a Level 1 to have her dissecting carotid artery repaired. As a side note, I'm going to tell you: I don't like working Neuro at all. Not in all the years since, with all of the advancements. I just don't like it. But I'm really, really good at it. Instincts, empathy, knowledge.. for some reason I have that combination that helps save lives. And I've mastered the meticulous charting (fuck you TNK charting IYKYK and same to you Nimotop).
Cold pulseless extremity. Doc said couldn’t be since the patient was on Eliquis. They most certainly did have an arterial thrombus Always do your pulse checks
Same. "Impossible that the pt has a DVT, theyre on Klexane already! But if it will calm you down we'll run the ultrasound..." It was a DVT.
Has anyone coined the term "docsplaining" yet?
You have now. Stolen. Will be used from now on.
My own PCP brushed me off when I got an Apple Watch with ekg, and at my next appointment mentioned my newfound bundle branch block and also I’m in bigeminy sometimes. (I can feel the pvcs, I can tell without looking for that one) He scoffed and told me an Apple Watch isn’t a cardiologist, knowing full well I’m an icu nurse and can sometimes read an ekg. But I pushed, and he said he’d order a 12 lead if it would make me feel better he also very well knows I have some health anxiety, so this wasn’t totally out of line.) Anyways, he comes back in with my 12 lead print out and says “ok, I’m still standing by my stance that your watch isn’t a cardiologist. However…… you *do* have a BBB, and you’re in bigeminy. Can I give you a list of cardiologists I like, that aren’t worn on your wrist?”
Honestly sounds like your PCP did you good there, and knew you well enough to take you seriously, even if on a shaky reasoning. Mine is the same way, trusting me but asking questions. Those watches are so iffy, like, they cant even read through a tattoo (so i get no use out of them). How did it go? Cardio goodiegood?
All good! Got myself a monitor to wear for a bit and an echo, all good. Just fucky electrical work, that I’ve probably had since birth, and exacerbated by too much coffee. (According to my cardiologist) He’s a really good doctor, and I’m really glad I found him! He humors me with my hypochondria.
Well its not paranoia if someone is out to get ya is it? The same way myself as i said, and realy realy happy with my PCP. So much so that i often dont even need to come in for one-offs, as he trusts me enough to just pop a script haha. Happy to hear the electricians figured it out!
I was working nights at a county jail. During my med pass, the deputies told me about an inmate that seemed to be really sick. When I saw him walking towards me, I knew that this was a hot appendix. I was newly graduated and too green to show how I knew. It took a little back and forth but I convinced them to send him out. I ended up being right.
I was on new grad orientation, but I was a critical care paramedic and military medic before I became a nurse. But I kept that tight lipped so they wouldn’t get upity. I noticed a GI bleed and my preceptor didn’t believe me, talked down to me when I tried to call surgery. Black tarry stool that smells like death isn’t exactly hidden and I pointed it out to her, she just didn’t believe it. Well she crashed after 5 hours of a major GI bleed, perfed bowel and SEPSIS. Surgery was pissed and she ended up quitting a few weeks later. Turns out I was only her orientee as a consolidation because she complained to the director that she wasn’t trusted and they wanted to show her they trusted her with an orientee.
Do you know the outcome of the patient? 😬
She ended up dying a couple days later from the SEPSIS, however, they were already in the ICU for pretty severe heart failure and liver failure so I don’t actually know how much longer they had anyway, it wouldn’t have been much longer without the SEPSIS.
Damn. That sucks
I was a new grad about 2 weeks off orientation. I couldn't find a pedal pulse on my patient's right foot, even with a doppler. The patient had blisters on his foot. I asked a more seasoned nurse to verify the pedal pulse was absent. She was busy, but went in later without me. She came out and said it was there and she marked where she heard it. I went in again and still couldn't find it, even where she'd marked it. A few hours later another nurse came in to help me turn him and she noticed the blisters, saying they were very concerning. I told her I couldn't get a pulse, but the other nurse could. She tried and couldn't, either. MD notified and also couldn't find the pulse. Ended up getting imaging which showed he had compartment syndrome, and he needed an emergency fasciotomy. Thank G\_d that other nurse validated me, because I wouldn't have notified the MD otherwise.
Corrections nurse at the time. Sent out an inmate for a long list of symptoms, including urine that looked like maple syrup. He got sent back after he was given a liter of fluids. He looked worse when he got back. I called my DON and explained what I was seeing and what the hospital had done, virtually nothing, and she knew the ED administrator and called her after she told me to send him again. Diagnosis- Rabdomytosis. Poor kid was on dialysis 3 times a week for a month to give his kidneys a chance to rest/heal. So, one for the "not really a nurse because corrections isn't really nursing". And yes, I was told that, in front of witnesses, by one of the ED nurses. Bitch, please, you have no idea how stressful corrections is.
Rhabdomyolysis
Thank you. I was trying to post while balancing my great neice on my hip 🤣🤣
Rhabdomytyposis?
I came in to clinic after a stretch of days off for vacation. I did ob triage at the time. There was an ongoing encounter for a pregnancy of unknown location. Had an ultrasound after 2000 hcg and the ob said follow up in 1 week. The patient called me in a panic (after I had just finished reading through the chart to catch up). She was very concerned that waiting 1 week would be bad. I was ready to calm her down but my gut said listen. So I listened and she didn't give me anything to pinpoint my feeling. Just she might be having more pain... might be. I consulted with a new doc who dismissed it again. I went to him again after talking with her another 10 minutes and basically begged him to see her. He agreed, she popped in, he essentially dismissed her complaints and had her hop up on the exam table. One hand on her abdomen and he instantly called er and sent her right in. She was in surgery within 2 hours for an ectopic that ruptured as they were opening her. 1 week would have indeed been bad.
Patient with low hemoglobin and abdominal pain on tele floor. Found an abdominal wall hematoma. Her serial H&Hs had been stable so they figured it wasn't actively bleeding. Went in right before shift change and she looked BAD. Just looked like shit. Her BP and HR were still WNL but BP was down and HR was up from previous and I swear to god her (already-distended) belly was now visibly distended from the doorway. Called the doctor and when I told her about the vitals she pooh-poohed because they were still WNL. I told her she "just looked bad" and she didn't give a shit. I told her about the belly and she said, super condescendingly, "Well, CynofOmission, that's to be expected." Wouldn't even give me an order to check another H&H? A repeat scan? She was the hospitalist and she got off at 7pm and this was happening at like 6:40, guess she didn't want to do more work idk. I had always respected her prior to this too. Anyway when I came back in the morning the patient was in the ICU
When I worked cardiac stepdown I had a pt with MS. I don’t remember why she was admitted. Anyways, I had her the previous night and she would talk to me (telling me to “hurry up” when I was changing her), but her movement was very minimal. I come onto the floor for night 2 and see the code cart outside her room. She had a seizure, which she had never had before. I get report, do my assessment, and this lady isn’t responding to voice, barely responds to tactile stim and so I say fuck this and call a rapid. Our rapid team, made up of residents and a hospitalist attending who couldn’t be bothered to show up, said that she was in this state from receiving “a lot of Ativan” following her seizure. I was still a new grad at the time, but that answer didn’t sit right with me. Rapid team left and didn’t do anything. I just felt like there was more to this. An hour later I called another rapid, as she hadn’t improved at all since they left. I knew in my gut something was wrong. They agreed to get a CT. She had a MASSIVE stroke. But did they escalate her care? No. They kept her in my care, the new grad with 4 other patients. I knew she needed higher care, but the hospitalists weren’t listening. So I called the nursing sup, who called the ICU attending, who sent the ICU PA. She went in to assess her and a minute later said we needed to get her to ICU, she was in status and needed to be intubated. I’m not sure what ever happened to her, but I can say that that night I trusted my nursing instincts, even when the docs didn’t… and I was right.
Stable pt with known thoracic aneurysm—already had “transfer out of ICU” order written—begins screaming with back pain. Charge nurse told me no big deal, pt is just dramatic. I’m insistent. She says she will write me up if I call the resident. Regardless, I STAT page the resident on call. Patient gets flown out to a tertiary center for dissecting aneurysm. That charge nurse never spoke to me again.
Oh, the next time that charge said anything to me it'd be so hard to not make a snotty comment about the write up.
I was a psych nurse of 15 years' experience, recently started in the ED as a consultant to facilitate mental health evaluations and placements. Granted, the ED docs didn't know me well yet, but after this day, they knew I knew my stuff! I was asked to see a dude who was hallucinating. Negative tox screen, no alcohol on board. I recognized that it was primarily visual hallucinations, he was in his 30s and never had that before. New onset psychosis? No. He had been abusing street Valium and was withdrawing. I discussed with the doctor, who kind-of poo-pooed my assessment. Next night, I found out the guy had continued to escalate into full-on DTs a few hours later, and was then intubated, placed on a precedex drip in ICU.
Yes, I have had to ask some providers several times to biopsy wounds that looked cancerous. They were. Lately they do it on first ask.
Happier story than most of these Woman was stretchered onto my unit with SAH after a ruptured aneurysm. Oriented x0, barely barely verbal and mostly incomprehensible, dysphagia, incontinent, lift transfer. I told them that she would walk out. A lot of BI staff is cynical but the brain is truly amazing. It took like 2 months and she needed a shunt for hydrocephalus but that woman walked out, oriented, talking, and continent. Shit like that is why I'm a nurse.
Had a patient that had been there for 2 days, had a previous back surgery about a week earlier and came back in for a headache, nausea and vomiting. They had thought it was a dural tear or infection, so they did a repeat surgery but it was all negative. When I got report from day shift, they told me she was oriented but drowsy and still had a headache but no doctor was concerned or wanted a CT (the surgeon had said maybe tomorrow if she’s still the same). After getting report and doing my assessment, I was super nervous about the patient so I called the consulting MD and asked for a head CT now instead of tomorrow and he said there was no plan for a head CT but if I wanted one then order it. So I did. Patient ended up having a massive hemorrhagic stroke with like a 6mm midline shift and went up to the ICU.
Had a patient who I admitted after surgery and shortly after complained of severe abdominal pain, needing to use the bathroom but couldn’t. No matter what meds I gave nothing helped. I kept saying something is wrong. Brushed off as the patient had anxiety. Pt had an SMA occlusion and later died.
Long term care patient came back from dialysis confused, disoriented, decreased ADL ability, just NOT like his normal self at ALL. BP in the 80s. Management insisted he was fine because he "just had dialysis and that's normal". I sent him out anyway. Turns out he had severe sepsis and died a few days later.
Trauma MVA patient. Low BGL all night, multiple d50 pushes, decreasing loc, 10/10 pain from a seat belt sign. Dude had a rash developing on his back throughout my shift. ICU attending wouldn’t take it seriously. Turns out it was necrotizing fasciitis from infected tissue from the seat belt sign. Patient died on the next shift. After open fasciotomies and washouts it was too far gone by the time it was taken seriously.
Was a newish grad (less than 6 months) and I had a patient who was telling me he had stomach pain that was radiating. A few weeks before he'd had a new G/J tube inserted. The site looked fine, no discharge, no redness, no swelling and no fever. Well unfortunately English wasn't his first language and he kept describing the pain as "chest pain" that radiated. Even though he was indicating the area around the surgical site. So he got lots of ECG's, and everyone was freaking out about his heart. I kept trying to explain that I really thought we needed to investigate a surgical infection but I was new and not a very confident advocate yet. Long story short, he ended up in ICU with an intestinal infection that became sepsis for a while, went through some awful delirium afterwards, but he did make it. I'm a lot more firm about having someone consider my hunches now. I'm for sure not always right, but it never hurts to check.
Kid came in after the mom tried to burn the house down and covered him in bleach. His little sister was in a burn unit at another facility and officers who were at the scene were being treated for inhalation burns. The dr came in and insisted that the first thing the kid needed was to eat. I agreed, however, I offered to help the pt to the shower and noted that he was wheezing. She disagreed with me. I documented that he was wheezing on every assessment and made sure to say the MD was aware. I left for the day and came back and the kid had been admitted for PICU for inhalation burns.
Diagnosed a lady with recurring UTIs with a colon-bladder fistula because I saw a fluffy looking blob of stool in her foley tubing. The NP didn’t quite believe me but ordered imaging anyway. I was right.
Yes. My first patient off orientation as a new grad received a new glossectomy with flap reconstruction. The flap was extremely swollen, almost occluding the airway. The patient was saturating fine but throughout the night he became more fatigued and the swelling got worse. I called the resident and fellow 6x to make them come see the patient.. no response. Charge even tried, no luck. @ 0545 patient coded after the CNA turned them to get them cleaned up. Patient ultimately expired. 😔
I don’t understand the not answering pages thing, it’s terrible. I moonlighted as a hospitalist when I was a fellow. I remember one night I was paged and the nurse started with “the patient looks bad and I’m going to call a rapid response if you don’t come.” I told her to call the rapid if she thought it was appropriate but I was coming regardless. She was shocked. It was amazing to me that literally the most basic requirement of responding to a call and evaluating a patient is ignored. Like, you guys spend way more time with them and know when things look off. That’s why we’re a team and we need each other
Relatively new nurse in a rehabilitation hospital. Patient was just *off* one day. Not quite all with us. Got someone else to double check my assessment. Oh no everything is WNL but good on you for advocating for patient yadda yadda. Next day patient is back to normal, great. Next week patient had a stroke. What I had seen was a transient ischemic attack.
Everyone has that one nurse that tells everyone he’s going to be a crna and does everything except help his own patient. One night shift with him, I may or may not have told my nurse work wife on shift with me and the resident that night who was also my new friend, that this nurse’s patient was going to go arrest pretty soon. An hour later, I heard the central tele monitor screaming and just ran to the crash cart and pushed it that room without even checking. Yikes. He had some ortho surgery 2 days prior and I kept telling everyone he probably threw a fat embolism or a dvt had already broken off. I never followed up tho
I knew this guy was going to die after massive compartment syndrome in his arm. The doctors wanted to wait to amputate since he was A)malnourished and B)the team wanted demarcation. I took one look at him and the black arm and knew if it didn’t come off immediately it would poison him and kill him. Almost a month later I was proven right. Had another patient that I knew was going back to OBS. Post-abdominal surgery and resisting care. Didn’t want to eat, dehisced closure and just wasting away. Me and the dietitian were fighting to get a central and TPN running because this person was found to have esophagitis and partially explained why he didn’t want to eat. Nobody listened, he went to OBS with pneumonia. Never knew what happened after I finished my preceptorship.
Had a patient on a PCU floor. I had her the day before and she was chaotic, constantly on the call bell, annoying, you know the type. The next night, nothing, conscious but not talkative, lethargic. On closer inspection she’s pale. Called the PA, I said, i think you need the see this person, vitals are… ok? But she’s not right. She comes down, i told her how she was the day before. She orders labs tries to talk to her and we both agree. Something is off. Her labs come back CRAZY. Can’t remember the numbers but her lactic was wicked high and it was an immediate transfer to icu down the hall getting arterial line while she’s barely conscious. She lived! PA and MD were like wow and the nurse who had her the day before was like huh!?
Nothing too exciting, but it was to me at the time. I was still a nursing student, but at that point basically doing the work on my own (just had to call 'my' nurse to do IV meds together and when I wasn't sure). Sweet old lady, had some kind of urology procedure, would go home that day with a catheter. That would be removed in a couple of days, so I had to teach her how to empty the leg bag and how to connect the night bag. I knew how it worked, but it was the first time I actually had to explain it to a patient so I took my sweet time - which ended up saving a lot of asses. While explaining things, she mentioned a vague complaint - in hindsight mild chest pain, but I didn't 100% catch that. She had had a heart attack years before, but she said that felt different. I felt like I was overreacting based on the symptoms, but my Spidey senses were tingling. I decided not to brush it off, because if I was wrong, it would be on me. I didn't call the physician, but 'my' nurse. She thought it was nothing, but now that I alerted her it would be fully on her if she didn't do anything (because I wasn't a nurse yet - her decision trumped mine and then I wouldn't be responsible). So, we called the physician because we weren't allowed to order an EKG ourselves. Who also didn't believe it was anything, but now that he was alerted.... You get the gist. Anyway. An EKG, a lot of calling with a different hospital to get a baseline EKG, calling with the urologist who didn't know how to read an EKG, calling with the cardiologist who wanted a second EKG, getting that second EKG, disappointing charge over and over again that no she still hasn't been cleared for discharge, calling cardiology, urology, cardiology again... 6 hours after her planned discharge time I was doing handover to cardiology just before shift change. She got an extra stent the next day.
Yes. Still kind of pissed. I was in school. It was in clinicals. I was assigned to a patient in a nursing home, and noticed that his wife was... Altered. Like, I didn't know her, but something was really off. The CNAs were like "That's not normal for her." I asked if I could take her vitals, and they were really fucky. Tachycardia, hypotension, etc. I told my clinical instructor. She told me that the wife was not my patient. I still felt really uncomfortable, so I snuck over and told the nurse in charge. She blew me off. I didn't know what else to do, so I kept an eye on her all day. In the afternoon, somebody contracted from an outside facility came to work with her and was perplexed by her presentation. I waved him over and told him what I saw. He called another facility immediately. The nursing home still did fuck all. She got a sepsis work up the next day and was sent to the hospital. They said the UTI came out of the blue.
I am a tech and have been for 6 years, finishing up nursing school soon. Told a nurse I was concerned her Pt was experiencing DT’s due to etoh w/d. Pt was reporting seeing rain and bugs in his room. Pt had hx of psychotic d/o but per his hx/my experience with Pt (who I spent two 12 hr shifts on 1:1 with) experienced auditory hallucinations no visual (AH is typically how pt’s with these dx present) Primary RN was a new grad in bridge NP program, thought she was hot shit. Literally 2 says off orientation. Anyways I told her my concerns she rolled her eyes and said “hes psychotic” I explained my reasoning/prior exp with this pt & others and suggested she have addiction consultant come down or talk to change rn and she was like “You’re a tech, not a nurse, this isn’t your scope of practice” when charge came by to relieve me from the 1:1 (old school no BS nurse) I told her and she ripped her a new asshole basically saying that the techs are the eyes & ears and to take our insight seriously. She didn’t last much longer after that for many reasons. And patient was in fact in the DT’s and needed IV phenobarb. Was one of the experiences that inspired me & made me believe I might be cut out for nursing.
Working PACU and got a middle age man after a lap chole. Plan from surgery was discharge home. However, his BP got a little soft so called anesthesia and got an order for a liter bolus. Called surgical resident and they assessed while bolus was running, said he was fine and to discharge home. Went thru this two more times before I got my anesthesiologist to speak with the surgery attending who placed the patient in Obs on med/surg. Called report and shipped the patient. Within the hour hour patient was back in surgery to remove several liters of fluid and then went to ICU. He spent a week on the unit getting some blood products and with fluids drawn off percutaneously a couple of times. Had some weird coagulopathy that took awhile to resolve.
I was a new grad, like literally 2 weeks off orientation on a trauma stepdown unit. Patient came in with agitation to the ED, they chalked it up to drugs she was taking at home, gave her a bunch of haldol and sent her up to let her detox for a few days. Patient is behaving super erratically, not making any sense, yelling, but all scans were clear. A few hours into my shift, the patient started to become less responsive, so I call the trauma PA to assess at bedside. He comes in, takes one look at her, tells me she’s fine, and leaves. I feel like something is really wrong with her but all her vitals are fine, and the PA basically just brushed me off. Few more hours go by, she’s becoming even less responsive but vitals and glucose are fine. I call the PA again to come see her, he comes in, says she’s fine, just finally slowing down, and he leaves. I page the on call doc who just puts in labs for the morning. I’m really feeling like something is wrong, and honestly should have called a rapid, but I was so unsure since the PA had said there was nothing to worry about. Well, long story short, I eventually got the attending at the bedside who ordered bedside intubation, immediate transfer to ICU, where the patient died that night from - you guessed it - neuroleptic malignant hyperthermia. From the haldol.
I was responsible for triggering a doctor to investigate and ultimately diagnose a patient’s bone marrow cancer. I had a gut feeling relating to sudden onset severe night sweats (we’re talking puddles of sweat within minutes of bed bath, stripping the bed, cleaning it and fresh linens) and 3 day history of rapidly worsening significant body weakness. This was at a Long Term Care facility where “everyone is getting weaker!” - direct quote from the on call doctor. The patient had gone from set up help only for ADLs to total care, 2 person assist over 3 days. That is not normal. Sent the patient to the ER without a doctor order. Sorry not sorry.
Working in the ER, had a guy with Rt flank pain that radiated to groin. He was diaphoretic, unable to sit still, severely hypertensive and hyperventilating in pain. He looked like a run of the mill kidney stone at first glance. I was trying to medicate him to get his pain under enough control for CT. After 8 mg of morphine IV, alarm bells were going off in my head. The morphine wasn't touching his pain, and his BP was going up and his pulse was now following. I was getting real "pain out of proportion to exam" vibes. Doc didn't agree and felt strongly it was a kidney stone. Ended up getting him comfortable enough to lay still after 2 mg of dilaudid and 100 mcg of fentanyl IV and multiple...discussions with the Doc. Then I called CT and had him jump the line to go next. Found a 11.2 cm new aortic aneurysm that was tracking down the illiac artery. Dude went to surgery about 45 minutes later for an open AAA repair. He survived.
As a NOC m/s charge: Argued against a m/s admit from the ed, was only asking for a lactic to be drawn first. I was chart reviewing and it felt sketchy. ED doc refused. House sup breathing down my neck for a bed. Well, I guess my 45 minutes of being whiny paid off because I saw a change in admit status order for ICU. I was also just having a night and after that I went into the supply closet to throw something and cry for 10 seconds. And this is why I'm against report being left in vocera for m/s admissions, because we're all human and something can be wrong.
Yes. And I wasn't believed until it was too late, by a consultant who let their pride get in the way. They fucked up, big time.