My First Cardiac Arrest Experience
24 Mar 2011 Leave a Comment
in Placements Tags: cardiac arrest, COPD, CPR, crash team, death, emergency, oxygen, student nurse
This isn’t a very pleasant post, but a lot of student nurses talk about how a cardiac arrest experience is something they don’t look forward to (although some do want to witness one as they want to take part in the whole excitement of CPR).
My Intensive Care Unit post got quite a few views so I’m hoping this one is as interesting.
I’m over halfway through my nurse training now, and am currently training on an emergency surgery ward. On my first day on a Monday, my mentor asked me “Have you seen a cardiac arrest yet Sarah?”
I told her I hadn’t. She replied “Really? Well I’m warning you; I always seem to get them with my patients – you’re very likely to see one working with me”.
Four days later on the Friday it happened.
A had been caring for a very ill lady on the Thursday night – she had COPD (Chronic Obstructive Pulmonary Disease) and needed to wear a nasal cannula to deliver her oxygen. Unfortunately due to illness, she was very confused and agitated and was refusing to wear her oxygen. Her saturation levels had dropped to around 70%.
She was in severe pain and felt very unwell but refused all offers of treatment. With her daughter, I spent much time trying to persuade her to accept oxygen therapy and pain relief.
She eventually got very annoyed with me and my voice (which I’m not surprised about to be honest – it can’t be nice having some 23yr old kid staring at you and repeating things you don’t understand) and told me to shut up. With this, and the risk of causing her more agitation, I left her with her daughter and the night nurse and finished my shift at 8.30pm.
I was back on shift the next day (Friday) for 7.30am. My mentor and I decided that we would care for the same patients again – including the ill lady from the night before, for the sake of continuity. The night nurse gave us our handover and told us that the ill patient had been very difficult to look after – kicking, biting, yelling and continuing to refuse all care and treatment. Me and my mentor didn’t like the sound of it, but planned to do our best with her.
We left handover at 8am – a different patient was screaming in pain and needed a certain drug, so I decided to go to the ward opposite and ask if they had this drug in stock. I returned to my ward to see the crash team and my mentor gathered around the ill patient, about to start CPR on her. Someone had gone in to the bed area to wake the patient up for breakfast and realised that she was unresponsive.
This is an excellent and dramatic video demonstrating successful CPR – definitely worth watching:
It was quite chaotic. The curtains couldn’t be fully drawn because the crash trolley was in the way, so the patient opposite could see some of what was going on. There wasn’t enough room for everyone and a lot of patients were in earshot of what we were saying and doing. I was the only person available to run in and out of the clinical room to get syringes and flushes and any other pieces of equipment needed. The crash team kept going with the CPR for what felt like almost 10mins, whilst checking her blood sugars and giving her adrenaline. I couldn’t really take in everything that was going on, but sensed that this was not going to save her.
CPR looks a little brutal – her ribs were being forced down so deep it made me hold my breath, and the mayhem was quite overwhelming.
The crash team eventually stopped and declared the patient dead.
Before really having any time to think, her husband and daughter were on their way after a couple of phone calls. I helped the healthcare assistant with stripping the patients body of any cannula’s and plasters, wiping away any blood and tidying the bed area. I felt quite numb to what had just happened and was more concerned about how her husband and daughter were going to react. Later that day I joined my mentor in carrying out last offices for the patient.
Unfortunately, with this being my first experience of a cardiac arrest, I don’t feel like I learned as much as I would have liked to. Perhaps giving myself the opportunity to take part in CPR would have made this a more valuable learning experience, but at the time, taking part felt like something I didn’t have the knowledge, skills or even initiative to do. It was a very sad experience, but I suppose now I can understand how very quickly a person can deteriorate, how people deal with the news of a death, and why the debate of patient restraint comes about so often.
Intensive Care Unit; a learning experience not to be forgotten
12 Mar 2011 Leave a Comment
in Placements Tags: acute, arterial lines, central venous line, death, ICU, intensive care, intravenous, manchester, nursing, oxygen, student nurse
So I’ve just finished a 5 week placement on the Intensive Care Unit (ICU) at a hospital in Manchester, and am currently enjoying a week off. I have done a lot of sleeping. It feels like I’d been on ICU a lot longer than 5 weeks, because the amount I learned was unbelievable.
I am currently studying the Acute Care in Adult Nursing unit at university, so ICU was a perfect fit for that unit. Acute care can be considered as an urgent event in healthcare, whether that means a person being in sudden pain from an injury, or a person choking on a bit of potato.
On ICU it can be things such as a patient’s O2 saturation levels suddenly dropping from 99% to 80%, or a patient going into urinary retention and not being able to eliminate toxins and waste.
The action taken in these situations is the ‘acute care’ given, such as sticking an oxygen mask on someone and giving them 15lites of O2 a minute, or inserting a urinary catheter.
ICU consisted of an awful lot of Intravenous medicine, bed bound patients, urinary catheters, blood samples, chest physio, machinery, ventilators, tracheostomies, suction catheters and death.
It looks a little like this, only the machinery is far bigger:
Above: I could not find the artist of the above image so I don’t wish to take any credit for it – I just really like it.
A typical day on ICU – a whole day of new learning experiences:
At this particular ICU, an early shift would start at 7.30am and finish at 2.45pm. A 7hr shift with a 15min break (I much preferred early shifts as more care was given than on a late shift). You look after 1 patient per shift.
If you want to learn how to prepare IV medicine then ICU is the place for you. Just as I’d finished preparing IV drugs for 9am (aseptic technique, syringes, needles, calculations, potions and all) it would be time for hygiene care to be given. Teeth brushed, Chlorhexidine mouthwash begrudgingly given (it tastes AWFUL), full bed bath and moisturiser massaged into wherever needed moisturising. Sometimes a patient would be hoisted into a chair (if they were conscious) to help them regain muscle strength. Fluid levels, blood gases and paperwork would then be completed.
By the time this was all done, it would be time for afternoon medication. Back to the clinical room! Once the afternoon drugs were completed, any other tasks to be done that day would be completed – this could be surgery, replacement of lines, inserting a tracheostomy etc.
Most patients on ICU have a Central Venous Line inserted for the majority of their drug administration. This is a catheter that is inserted into a large vein in the neck, such as the internal jugular vein:
Above: A patient with a triple-lumen CVL inserted for antibiotic drug use. Image taken from http://bit.ly/gvmQOj
Makes it much easier with CVPL’s as large veins can take the pressure of a lot of drugs being administered several times a day.
There is no doubt that ICU was one of my most difficult placements because of how much I had to learn about the ventilation system – I will not even start going into it. The majority of patients are also admitted under sedation and can be sedated for days – this makes the work heavier and more time-consuming as you are moving a patient’s full weight when they are unable to move. Plus there are a huge amount of wires and tubes going in and out of the patient – a patient can have 3 syringe drivers on at the same time, plus 3 or 4 suspended drips, an NG and NJ tube (you can google the difference), a urinary catheter and sometimes a drain from a wound or an infected bodily organ.
The clinical technology used can be intimidating. Blood pressure cuffs are not used on ICU – arterial lines are used instead to get a constant record of the patient’s blood pressure (check this out http://bit.ly/fy5XWJ). It can also be used to get blood samples so the patient’s blood gases (blood ph levels, CO2 levels, sodium, potassium, glucose etc) can be checked at regularly intervals.
Death was definitely something to get used to on ICU – my first patient died on my 2nd shift. 1 or 2 patients died a week during my time there, some of them not that old and some of them leaving behind people who then had no one to care for them.
Luckily for me, the staff at this ICU were more than amazing. Everyone was very keen to teach me and I was made to feel very involved in patient care. I was given many opportunities to do anything that I was able to as a student nurse, which gave me the confidence to use more of my intuition. Shame that ICU also meant that I was completely knackered most of the time.
If you get a chance to train on ICU, make sure you get stuck in and do everything you are able to do (obviously, administering IV medication is a no-no, as is deciding to mess around with sedation and morphine levels without being told to). You will leave realising that you knew less than you thought beforehand. Unless you’re a registered nurse of course.
ICU could end up being my elective placement in 3rd year 
