Hey guys, I thought I would tell you about an incident that occurred on monday afternoon on prac. I was walking out of a pts room with a physio when the wife of another patient came and told us that a patient was falling out of bed. We assumed we were going to get the pt back into bed. When we got there the pt was lying on his back with his legs over the side of the bed. He was quite drowsy but trying to open his eyes and breathing. There was some fluid in his mouth. The physio sent me to get his nurse, I looked for his nurse then I was going to grab any old nurse when the emergency buzzer went off. It was a bit chaotic but the patient had stopped breathing soon after I left so the physio had pushed the button and started CPR before the Dr took over. As it turned out this pt was a DNR and resus efforts were stopped once his file was found. The whole process from when we went in to the room for the first time and when the patient was dead was less than 10 minutes but it didn't feel like it.
This was the first time i've ever seen someone die and it wasn't particularly pleasant. However you then go and see your next patient and try not to think about it and focus on them. It didn't hit me or the other physio until we got home and had our separate mini meltdowns.
Preceding this incident, I asked my supervisor about what exactly happens in the case of emergencies i.e. if you're the one there do you start CPR etc. She said it was a silly question and it wouldn't happen. The reason I asked this was that one of my patients is a DNR and I wanted to know the different procedure in the case of a DNR compared to the normal situation. I know it seems obvious but I didn't want to get into the position then not be 100% sure I was making the correct decision.
Obviously it did happen and I would have felt better about having talked it over prior to it happening. As it happened 2 more pts died on the ward today thankfully I wasn't involved. This ward had a 31 day run of one person dying per day so it does happen.
I thought this might be a good post for people just to quickly think about what they would do in that situation, if you are 100% sure that what you would do is the right thing, and also in case you, like my supervisor, think it isn't going to happen, it does so it's a good idea to have thought about it a few times.
Hope everyones enjoying their last week of prac,
Anna
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3 comments:
Hello Anna
Thanks for sharing that experience! It reinforced to me that such incidents can certainly occur especially in the inpatient setting and got me thinking as well what I would do in that situation. While I was on my cardio placement, I was told should any emergency occur, press the buzzer and nurses will rush in promptly with the resus trolley. Got to witness one false alarm previously and indeed the nurses were fast to act. I bet they must have had quite a number of practice trials! It seriously didn’t occur to me at all regarding CPR because my supervisor didn’t mention about that either. Come to think of it, we went through that course for a reason and it’s a requirement to have a valid cert before we go on our placement I believe? I was surprised that your supervisor actually thinks your question was silly… because it’s so much about life and death and our ability to make a difference if we are present at that moment. I do think that under those emergency situations, we got to just react because every second counts… what I mean is that I will rather start off CPR and stopping it later when someone tells me it’s a DNR than not starting it and realizing he/she isn’t a DNR. I am not sure if this has been put in place already but perhaps patients who are DNR should have that written by their bedside or have a particular colored label by their bedside (if there’s a need to be more discreet)? Such incidents can definitely also occur in the outpatient setting – I can appreciate much better now having those emergency buzzers introduced to us in the musculo outpatient dept I am having placement in currently. I think all of us should have CPR knowledge & skills ready in our accessible memory store as long as we are working with patients; perhaps particularly crucial in the outpatient setting (I just realized now) because the time for the emergency team to arrive is definitely longer than in the wards! So we play an even more crucial role in saving lives here!
Cheers, Peiying ~
Hey Anna,
That sounds like a very intense day. Thanks for letting us know. Had the physio who started the CPR not seen the DNR form or was she just doing CPR anyway until the file was found as a precaution?
I hope you are feeling better now and coping with the situation.
Brent
The pt was completely unknown to both of us and the form is kept in their main file in the nurses station. I think it's ridiculous that they do not have some system in place so that you can look at the patient in their room and know they are a DNR. There are some very big implications for resusitating someone who doesn't want to be.
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