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| My valuable pin of achievement on Basic Life Support. Award given by the Philippine National Red Cross - Quezon City Chapter |
May 17, 2012. I received a census of not more than 25 patients all. With my 2 RN HEALS (Contractual Registered Nurses) and me, the Staff, as the Charge Nurse.. During Endorsement, I had this seemingly familiar anticipation with one particular patient. Which.. I was afraid to convince myself it will actually happen. Right after, I immediately took a moment to check on his condition.
A 56 year-old/male and has been diagnosed as "New Growth Pharynx", a mass has seemed to occlude the opening of the esophagus from the mouth. He's been admitted in our institution for like 4 days ago. And since then.. he's not taking anything (food, water etc.) through his mouth. In short, he's been, in no doubt, starving.. he cannot tolerate eating. A nasogastric tube had been numerously attempted to be inserted, but the intervention apparently failed. So, while his doctors tried to figure out one appropriate action, we managed to maintain his intravenous line in condition, and kept him in Oxygen support, and a frequent (every 4 hours) of nebulization, which worked for him in the first few days.
Until then, the moment I checked on him, he seemed to be in his same condition as before. His vital signs were the same, a BP of 110/70, a respiration rate of 29 (which is understandable for his airway problem) he's pale, he's leaning forward the bed (his comfort position to breathe properly).. with that I ignored the hunch of actually having a dreaded "code" that night. I went back to the station and attended my Pay patients. I was sooo drowsed, and my eyes were falling, and dreamland was calling... I was soooo.. sleepy.. That i had to help myself with a cup of coffee.. Until...
Angel (one of my RN HEALS) came up to me, and reported that, that patient apparently became unconscious. And my adrenaline engine ignited for a respond. I rushed at the bedside, his Vital signs came unappreciated. BP=0, Heart rate=unappreciated. CBG=erratic. No spontaneous breathing,.. I hurriedly borrowed the AmbuBag (from my other one Mechanical Ventilation assisted patient (Oo, may isa pa akong toxic na pasyente, which at that time ay nasa on "Do not Resuscitate Status" naman.) and hooked it to the coding patient. I hurriedly referred it to the Resident on Duty, and was attended right away. In constant ambubagging to oxygen at 10 liters per minute. Clerks and Interns initiated the cardiac massage. I brought our emergency medicines, broke an ampule of epinephrine, and was given thru IV bolus. Broke another ampule, and prepared for the next push. I asked my other nurses to borrow the ECG machine at the next ward... Its not that I forgot to prepare one thing.. the Intubation set.. All the while Ive been thinking of it, but why on earth didn't my self do it..? That I had to prepare other things more important than that. I assumed it will only be useless since the mass has been so perfectly occluding.. That I, again, assumed.. they will do the Tracheostomy instead just like what they did before.. My attending residents were lost. They were not telling me what they were actually going to do. Were waiting for a Senior resident to help out. (Who were currently operating at the OR..) But.. minutes delayed, I decided to prepare the Intubation set anyway, in time as the 3rd yr resident appeared. I put all the ECG leads in place, ran it.. and revealed a flat line tracing. Intubation took time, but done. Chest Compressions and Ambubagging continuously done. 20 minutes later, the patient has been pronounced clinically dead. It was 12:21am of May 18. I would not elaborate the complete interventions done.. But.. All I can say, is that.. we did.. OUR PART. What made me a little so concerned about this was.. After all the commotion, the doctor actually told me. "This is not anybody's fault. This happens. We're not prepared. You are not prepared." Those words sank in the deepest of my soul. I interrupted and told him... "Doctor, hindi po sa hindi kami nakahanda. Nakahanda po kami, naghihintay lang po kami ng orders ninyo." I came from the Medicine Ward. Has been assigned there for 7 months. And these happened to us almost everyday! And I was trained on these kind of situations. I just didn't want to break any superiority in that particular situation, i managed to prepare what i think were helpful. I believed, it is in their ordinance to fully assess the situation. I wont push the epinephrine every three minutes, without their order. They had to assess first...
I began charting at 2am. Yes almost like 2 hours since I had an expired. Those words as mentioned.. were penetrating. i was out in space. I was assessing myself. But in the end, I was convinced, I did my part. I'm not pointing anybody's fault either. This is going to be another lesson learned for me. Sometimes, its ok to break the chain of command. If you think its right, just do it.
