Submitted 2022-08-09
Understanding the processes involved in an emergent situation can mean the difference between life and death for your patient. I have been in nursing for over 17 years, although my interest and work in the medical field started long before that. I began my career as a CNA. I worked in long term care for a brief stint, caring for the elderly and learning firsthand what end of life looks like for a patient on hospice care. I stepped into the operating room as a CNA next and was on-the-job trained to become a scrub tech while I continued furthering my education. I was a single parent, working full-time, and began nursing pre-requisites at night through the local community college. It was at this point that I truly began to understand and appreciate those working in the medical field. I had no firsthand experience with a medical emergency until I started my schooling in the LPN program.
During clinicals, I was on a rotation in the OR where they also performed outpatient procedures such as lumbar punctures, facet injections, and IV infusions. I was assisting a CRNA with a routine lumbar puncture. The patients’ vitals were stable, she was in no acute distress or pain, so we began to prep the patient for the procedure. We positioned her in the prone position, careful to ensure all monitoring equipment was in place, and the CRNA opened his sterile tray and began to prep the lower back area. He talked calmly to the patient throughout this process to ensure she was comfortable and could verbalize an understanding. I was so impressed with his bedside manner and the gentle way he comforted her. Once the area was prepped with betadine, he explained that he was going to use local anesthetic to numb the area to prevent her from feeling the pain of the lengthy needle that was to follow. She verbalized an understanding and was ready for him to proceed. He drew up his 10ml of Lidocaine, and then verified her name, date of birth and allergies one final time before proceeding.
He slowly pricked the skin, in which she grimaced slightly. I was standing at the head of the bed monitoring the vitals machine and the patient. Her eyes were open, she was alert and able to hold still as directed. Vitals looked good – BP and pulse were normal, O2 was 98% on room air and her breathing was even, not labored. He injected the local and withdrew the needle. That is when things suddenly took a turn. I looked down to tell her he had finished with the hard part and noticed her eyes had rolled back. I quickly glanced at the monitor and saw that her O2 level was dropping, 96, 94, 93, 89, 87, I alerted the CRNA that the patient was not responding to commands and that is when the monitor made a loud continuous beep, and he pressed the call button on the wall. We quickly flipped her over and palpated for a pulse, nothing……. He handed me an ambu-bag and told me to administer breaths as he began compressions. In what seemed like an eternity but was more like a minute the whole bay was full of medical personnel. I was advised to step back at this point and that is when it really occurred to me. This patient just crashed, she just died, right there…. I watched in awe as they worked like a well-oiled machine. One person doing compressions, one person managing the bag, another starting a second IV line while another was following the direction of the doctor, giving epinephrine, and one getting the defibrillator ready. In no time flat, they had pads on her and gave the first shock, nothing. They continued to work on her, second shock, nothing. Finally, after the third shock they had a rhythm. It was at that time the doctor realized there were several students watching and asked that we leave.
I will never forget that day. It was the scariest moment in my career. Now, as I have worked in the ER and managed a crisis or ten, I see how important it is to have the knowledge and confidence in your capabilities to save a life. I have experienced it firsthand. I have been the person giving compressions. I have been the nurse starting that second or third line of access. I have been the nurse administering breaths. I have been the nurse administering medications during a code, and unfortunately, I have also been the nurse at the doctors’ side telling a family member we were unable to save their loved one. Of course, there are those positive outcomes in which we provide them the relief that we were successful, too.
Being prepared for an emergency is the best thing you can do for yourself. Ensure you are aware of code protocols within your organization. Ensure you know where the crash cart is located, that suction and oxygen in your patients’ room are in good working order and most importantly, know your patient. Be sure you are aware of their code status, are they a full code or a DNR? Know who is in the building with them or who you need to contact in the event of an emergency. Know their medications, allergies, and medical history. All these pieces are crucial in the care of your patient anyhow, but due diligence on your part, can save their life.
Having the ability to maintain professionalism while still being empathetic to the situation and the family is a skill all its own. Taking care of yourself, your mental health and physical health is also crucial. Be sure you get adequate rest, relaxation time, and time away from work, I mean, mentally away from work, it is so important and can prevent burnout. With burnout, your awareness can become limited, reaction time delayed and inability to cope can occur. TAKE CARE OF YOU SO YOU CAN TAKE CARE OF OTHERS. I am grateful for the knowledge base I had to aid in a crisis and even more so, blessed that I chose this path for my career. There are times when it is not rewarding or gratifying, but they are exceedingly rare. I am now an RN and have been since 2011. Nursing is my career, my dream, and my biggest blessing.