You're the Sleuth!

Thursday night I had given report to the oncoming shift and was ready to leave the hospital when I saw a mass of people run into one of my patients rooms.

Her eyes were pinpoint, she had slow, gasping breathing with expiratory grunts, was completely flaccid and did not respond even to a corneal stimuli. BP was 78/38.

Thirty minutes ago this woman had been conversing appropriately with me with stable vital signs.

For Student Nurse on a hum-drum Thursday night, this was some serious action!

I wedged myself in between the head of the bed and the wall; I was both out of the way of the scrambling team and I could manage the patient's airway.

The charge nurse barked orders, and the team worked smooth and hot: "Get another BP! Whose got the blood sugar machine? Someone get a 100mL normal saline bolus running. Call the ICU for a transfer. Order Chest X-ray, blood ABG's STAT. Someone write this stuff down. And whose calling her doctor?"

A specialized team of ICU and hospital staff rushed in to help us stabilize the patient and figure out why she had suddenly collapsed.

I was trying to formulate hypothesis as to why this patient had gone so bad so quick.

She was in her 90's, had cardiac surgery less than a month ago with a slow recovery, a recent GI bleed, a history of CVA, a recent moderate drop in her hemoglobin/hematocrit as well as a recent moderate increase in her white blood cell count.

In the last few hours she had gotten Acetaminophen (Tylenol) for neck pain 4/10, Droperidol (Inapsine) for chronic stomach pain 8/10, and Pantoprazole (Protonix) to protect her stomach from ulceration and further GI bleeding.

Any ideas yet? Check back tomorrow for the answer and a patient update!