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Sometimes you should be careful what you wish for.....

 

For instance, one night our ER was going down 2 nurses at 3am so I was assigned to go there for 3am -7am to cover.  Usually when they are going down 1 nurse I just go as helping hands since I have to cover any METs or Codes that may occur during that period too.  But this night they were particularly short so I was asked to take an assignment and the charge nurse would cover me if any emergencies happened elsewhere. 

 

I was given 3 beds in the observation area but only 2 were filled.  They were both going to be admitted but there were no beds in the hospital so both were holds.  Both elderly and both settled in and asleep.  A set of signs on each, a pair of assessments and a talk with one who had family and I was in the clear. 

 

I then asked the charge nurse several times to give me another patient to fill my other bed but she said no as she already had 3 of her own and didn't want to cover 3 more if I had to leave.  So, I helped others and waited and waited and waited.  And, of course, being me complained a bit as to how useless I was being.

 

Then about 5:50am the triage nurse doesn't consult with the charge nurse and puts a patient in my 3rd bed.  I go in to see what he is and find a young man in his early 30's.  She tells me he had just had a syncopal episode at work with a LOC for approx 10-15 seconds.  Kinda impressive but I'm not really expecting much.  They rarely repeat themselves for us nurses!! 

 

The tech gets an EKG, I get him on the monitor and we start chatting etc.  I'm actually starting to think like an ER nurse (scary for a critical care nurse at heart!!)  and go get a rainbow of lab tubes to get his blood while I put his IV in.  I start an 18 in his AC.  As I'm getting the last tube of blood I hear the monitor start to beep and look up.  He had this whole time been a nice NSR in the 80's with no ectopy or anything funny.  Now he's in the 40's!!  Yikes! 

 

I ask him how he's feeling and he initially says fine.  Then changes his mind and says he's a bit nauseated.  I look out and there is NO ONE to be found at the nursing desk!!  Oh shit!!!!!  I then look back at the monitor and his heart rate is now 30's and he's telling me that he is really feeling quite nauseated and not good at all.  I look again and see another nurse and barely get her attention but luckily she comes to my aid.  She gets some atropine and goes to flush my IV site and in my haste to tape the site in I had taped it too far down and we cannot get the flush syringe on the catheter.  Oh shit BIG TIME now as he is now in full blown asystole and his limbs are stiffening and he is totally out. 

 

I finally get the tape off, get the site flushed and she gets the atropine in.  Not sure if his heart restarted on it's own or with the atropine but it did restart.  Thank God!!  He then wakes and asks what happened.  The doc explains that he showed us what happened when he had the last syncopal episode and thanked him for helping in the diagnosis!!  I told him that if he really wanted to get my attention he didn't need to make his heart stop, that there were easier ways to do it!!

 

All in all he was in asystole for a total of 12.4 seconds by the monitor strip!  Needless to say he didn't tolerate it well at all.  Much more and he would have gotten some good ol' fashioned CPR.  He was close as it was.  Went to the CCU and got a temp pacer in his jugular and then a PPM the next day.  I don't think they ever found a cause.

 

But I definitely learned a lesson.........................when in the ER be careful what you ask for!!!!!