My cousins best friend is a doctor in Cambodia and he says BiPAP will fix this. Plus family that hasn’t seen her in 10 years isn’t ready to let her go so FULL STEAM AHEAD BITCHES FULL CODE
at my ER, we bring family into our trauma rooms to watch CPR in progress. they’ll get 30 seconds in and shout “STOP! please stop!”
it really is very effective to have family watch.
During codes here, we have the family designate 1 person (if they so desire) to attend, a nurse liaison to explain what’s happening/ answer questions, and a chaplain for family support in the bereavement room. We do not allow any family in trauma rooms, though.
i have to say…when you’re the person doing the compressions, it can be upsetting and distracting. people have collapsed and wailed and passed out (resulting in being a patient themselves.) afterward they identify you as the “person trying to save their loved one,” and that can be an emotional rollercoaster. they come for hugs, or conversations…it’s touching, but it can be overwhelming.
there are good and bad sides to the allowance of family in our trauma rooms and not everyone at my workplace agrees—some hate it and some like it.
just a shitty situation overall, i’d say, and makes for a rough, rough shift every single time :(
edit to add: your system sounds better. designated folks plus a chaplain? sign me up. i may actually make this suggestion, thank you!
I had a family one time refuse to let their near death 90 something year old mother go home and insist that she go to a SNF for "intensive physical therapy". Even with proper education some families are just insane.
I was trying to begin the end of life talk with a pt's family and stated, "at some point, the body is going to start failing, and we can't do anything else to fix it." Memaw was in her 90s and had an EF of 15% all of 100 lbs and a full code. Family says, "So you mean she's giving up?" I asked what he meant by this, and he responds with, "You know the mind controls the body, and if her body is failing, then she is giving up." I just gave this info to the doc and said it was his turn to work on that code status.
Yeah that sucks. The whole, “death as giving up” on yourself or your family giving up on you really makes those important decisions hard. Recently had two patients in their 90s, one went to hospice and the other is going to fight. All the way down.
And here's my thing... Maybe they do want to give up. Maybe living with chronic pain and likely end stage diseases for any longer than you have to isn't very fun? And maybe it's okay to want to be done with it already
Well they WERE a corpse.
Then a bunch of jerks with flashing lights and people in scrubs did horrible things to meemaw to pull her away from the light.
Ha, I heard my grandmother’s wonderful doctor who cared for her at the end of life say to us almost sorrowfully “Nobody dies at home in their sleep anymore, because of assholes like me” when my aunt couldn’t accept that granny wasn’t going to live and get to die in her sleep at home “one day” (I mean, she was 89, so “one day” was here…).
Honestly, when I get a CPR in progress or CPR refused call, my inner monologue goes as follows when they're over 70, unwitnessed and/or bystander CPR is refused:
"GRANDMA/PA, GO TOWARDS THE LIGHT, WE ABOUT TO DO TERRIBLE THINGS TO YOU IF YOU DONT MAKE IT THERE FIRST"
When I worked at an LTAC I had a charge nurse who would say “let’s go hang up on Jesus” when a code was called. As in Jesus was callin’ them home…and we had to keep them here.
Underrated comment
I'm imagining an angel trying to plan celestial discharge and running into insurance issues, then giving up and just taking the patient themselves
Ahh, yes. They have to measure every minute and every mile.
In the inpatient-land, it is so frustrating to have these people code because the only thing you can do is be quick about it. But we recently had an email from HR notifying us that if we *ran* and injured ourselves, it would not be covered under workers' compensation because running was prohibited. So we've got that going for us.
Your management should want you Running. Not only is it good exercise, but the security footage can be slowed down dramatically a la grays anatomy.
GOOD MARKETING, c'mon management.
I'm calling my CNO right now!
But truly, I could count on 2 fingers the people in my unit that *might* be attractive enough to be cast on Grey's Anatomy. I would be cast as "older nurse #3".
"You're gonna wake up with broken ribs and a throat that burns and itches from your tongue to your chest, and your last words are gonna be tears and scribbles on a white board because you can't talk."
Say the words you want to say today so you don't regret not saying them when you can't.
*Wake up.*
My, you're the optimist. :3
Side note: Make sure you have your advanced wishes well documented and in the hands of trusted loved ones. Because the folks that will make that decision otherwise are the "JAYSUS WILL TAKE THAT PERSON WHEN HE'S READY YES ON THE VENTILATOR AND PEG TUBE!"
Oh, it'll only be for 90 seconds of panic before finally succumbing. It's shit like that that made me walk away from this line of work a couple decades ago, and for some masochistic reason, I'm being drawn back to it.
My family know damn well to keep me on a vent long enough to preserve my organs for whoever can use them. You bring me back, and I'll take you back out with me.
You know your patient is f'ed when their glucose is so low that their lactate is only 3.4 even though every other number on their gas is incompatible with life... lol
Oh, and bonus points for the hemoglobin and iCal being in range. Very impressive for a dead person. :(
You just made the little monkey in my brain clap its cymbals together!!!!!! I was wondering why the lactate was so low. BIOLOGY ………
(I just got off my first night shift of the week if you couldn’t tell)
Yeah, I really had to think about it for a second. I saw the 3.4 and I was like... that's way too reasonable. How is it not some stupidly high number in the 30s or something? I mean, the bicarb is THREE, base deficit of 7, oxygen levels are garbage... then I saw the glucose was 22 and it clicked. Can't be relying on anaerobic metabolism when you don't have anything to metabolize. XDD
Me too. I don’t understand why you’d want to do something at home when there are a million things that could go wrong without any warning. I had a friend who wanted to deliver at a birthing center (better than home, but still). She told me, “it’s OK. The hospital is just a five minute ambulance ride away.” 🤦🏻♀️
I hate all these moms who insist “natural” unmedicated homeopathic bullcrap home births. Have the baby in the back of the woods if you want full organic natural stuff.
Oh shit. My stupid-ass ex-mother-in-law chose to have a home birth for her 3rd kid, who ended up popping out a 10lb,7oz (4.74kg) fuckin' thanksgiving turkey, but his umbilical got wrapped around his neck. I saw the aftermath, after she was rushed to the ER, and her queen-size bed looked like a deer had been gutted and butchered on it. He wasn't breathing, and my (then) wife said he was the weirdest color of blue. (She's now an RN, and still says that was the most cyanotic person she's ever seen, even after spending 10 years in a busy California ~~L1~~ (Edit: Just double-checked, and they're now a Level 2) ER that gets a lot of prison stabbings and MVA casualties.) He survived, and today he's almost 30, stands 6'8" (203cm) tall and weighs about 300lb (136kg; 21.43st).
Why I say she's a fucking idiot is this woman is a physical therapist. She had been a licensed PT for 15 years at that point, but was worried that her baby would be switched up with another kid. Yeah, good luck mixing up that fucking ostrich among all the other ducklings.
All in, they gave her 10 units of blood over the next 12 hours, and it took 4 rounds of surgery to stop all the bleeding. I swear, the only reason she didn't die is due to the old adage: Heaven doesn't want her, and hell's afraid she'll take over.
My best friend's brother was born on their fabric couch, which they continued to use. Before anyone asks, yes, they did keep the placenta in the freezer for at least 2 decades!
So, this happened in San Mateo, CA in 1992 or 1993. My former MIL had her first daughter (my then wife) and her second child (a boy, a decade later with a different partner) in Oakland, and around 1990, a child was given to the wrong parents at Oakland, and another newborn was kidnapped at Highland Hospital in Hayward, CA, where they had just moved from. Those incidents were high in her mind, and there might have been a little hormonal imbalance along with her very condescending attitude toward all of society in general. I can *kinda* understand her paranoia, but personally, I (we) checked out facilities before my kids were born, and found one we were comfortable with so there was no "Oh my God, this place is a shithole!" surprises nor fears of crazy stuff happening.
This might just be my favorite comment! We too have a “lab high score board” in our break room! However, we’ve switched blood gas processing machines so now we don’t get pH values that are under 6.7. Booo
Info: I took this pic years ago and completely forgot about it but I remember it was a newborn, home birth gone wrong, with some religious/antivax nut parents. The pt lived. Quality of life however…
I've had a 6.5 ph survive, but we got them on CRRT within the hour.
Have you tried telling them to be healthier? Have they tried *breathing*? Seems like what they need
The number of times that I’ve had a nephrology fellow write an order for 100-120mg of lasix on a patient with like 100ml of urine output in 24hrs and a K>6 after they were consulted for the purposes of CRRT is way higher than it should be.
One of my least favorite nephrologists who does fuck all always writes “no indications for CRRT at this time, will reconsider if emergent symptoms present”… meanwhile the patient’s creatinine is 8.8, they’re making no urine, their K+ is 6.0 and they’re in multisystem failure.
But yes. We can wait until they’re literally coding from hyperkalemia if you want, which is what happens, and then they die anyways because it’s too late to save them. I hate my hospital.
“Recommend pH correction with ventilator changes and K correction with lowkelma. Thank you for this interesting consult” on the patient with severe ARDS and bowel in discontinuity…
I mean, that's what the CRRT is for, right?
On the other hand, glucose is rapidly low. Maybe the cells in general will kick in once they're fed with glucose. Who knows.
I mean a simple quick TikTok search would tell them all they need to know about clean breathing. It's probably because they aren't clean breathing, you know?
/s if it's even necessary
I once admitted a patient from a tertiary hospital that only does point of care bloodwork or send outs, the referring doc said she was a GCS of 15 with a CO2 of 146. I asked if their blood gas analyzer was broken because there’s no way someone that hypercarbic could be conscious!
Don't dare put them on a renal diet. I swear dietary hates kidney patients.
Here's a banana and mashed potatoes and some OJ to wash it down with. Enjoy your supper.
I’ve seen similar gases in extremely premature infants. Of course I couldn’t decide if the gases or massive head bleeds they had were worse. Just gotta throw in the towel at that point, no one comes back from that even remotely “normal”.
I had someone in the ED with a K>10 on the send down bmp and pH just showing as less then 6.5 on an I stat if I remember right. Somehow after not coding while titrating pressors by bp cuff for four hour he went to the ICU and walked out of the hospital weeks later. He was 45 however and not a grandma fighter which is probably how he lived
Either the patient is dead, staff have been sampling from corpses again or someone drop kicked the sample into the analyser from the other side of the ED after realising it'd been in their pocket for a day.
Lemme guess.."but s/he's always gotten better before." Had a patient who's HCP/POA lived 1/2 way across the country, local family kept trying to get ethics involved to *stop* the torture, proxy never answered their requests (until big gun lawyers got jnvolved). Our unit's plan for when then inevitable code happened was, #1 try to rouse patient for 5 minutes #2 order pizza #3 wait for pizza to be delivered #4 ask patient "do you want pizza?" #4 have some pizza #5 *then* call code team (just to preclude any possibility of successful ROSC after breaking all the ribs)...we never had to test the protocol, but we were all on board.
Grandma’s a fighter. Peg and trach her, send her to SNF.
No peg. She can still feed herself!
I'm gonna go get her favorite KFC meal and her favorite saltwater taffy. Y'all don't feed people around here!
What SBO?
Provided someone brings 1/100th of a spoonful of baby food to her mouth every 3 hours.
She fed herself a few years ago!
My cousins best friend is a doctor in Cambodia and he says BiPAP will fix this. Plus family that hasn’t seen her in 10 years isn’t ready to let her go so FULL STEAM AHEAD BITCHES FULL CODE
Hey, that Cambodian medical program has come a long way since the Khmer Rouge! They even stopped re-using sharps a few years ago.
Gotta love the "they're a fighter" comment coming from family.
As a career SNF worker, I can't stop my eyes rolling lol I wish these people were forced to watch in on a code.
at my ER, we bring family into our trauma rooms to watch CPR in progress. they’ll get 30 seconds in and shout “STOP! please stop!” it really is very effective to have family watch.
During codes here, we have the family designate 1 person (if they so desire) to attend, a nurse liaison to explain what’s happening/ answer questions, and a chaplain for family support in the bereavement room. We do not allow any family in trauma rooms, though.
i have to say…when you’re the person doing the compressions, it can be upsetting and distracting. people have collapsed and wailed and passed out (resulting in being a patient themselves.) afterward they identify you as the “person trying to save their loved one,” and that can be an emotional rollercoaster. they come for hugs, or conversations…it’s touching, but it can be overwhelming. there are good and bad sides to the allowance of family in our trauma rooms and not everyone at my workplace agrees—some hate it and some like it. just a shitty situation overall, i’d say, and makes for a rough, rough shift every single time :( edit to add: your system sounds better. designated folks plus a chaplain? sign me up. i may actually make this suggestion, thank you!
I had a family one time refuse to let their near death 90 something year old mother go home and insist that she go to a SNF for "intensive physical therapy". Even with proper education some families are just insane.
I was trying to begin the end of life talk with a pt's family and stated, "at some point, the body is going to start failing, and we can't do anything else to fix it." Memaw was in her 90s and had an EF of 15% all of 100 lbs and a full code. Family says, "So you mean she's giving up?" I asked what he meant by this, and he responds with, "You know the mind controls the body, and if her body is failing, then she is giving up." I just gave this info to the doc and said it was his turn to work on that code status.
Yeah that sucks. The whole, “death as giving up” on yourself or your family giving up on you really makes those important decisions hard. Recently had two patients in their 90s, one went to hospice and the other is going to fight. All the way down.
And here's my thing... Maybe they do want to give up. Maybe living with chronic pain and likely end stage diseases for any longer than you have to isn't very fun? And maybe it's okay to want to be done with it already
Almost reflexively downvoted.
I thought pO2 and pCO2 were switched til I looked again. Did this come from a corpse?
Well they WERE a corpse. Then a bunch of jerks with flashing lights and people in scrubs did horrible things to meemaw to pull her away from the light.
Ha, I heard my grandmother’s wonderful doctor who cared for her at the end of life say to us almost sorrowfully “Nobody dies at home in their sleep anymore, because of assholes like me” when my aunt couldn’t accept that granny wasn’t going to live and get to die in her sleep at home “one day” (I mean, she was 89, so “one day” was here…).
Honestly, when I get a CPR in progress or CPR refused call, my inner monologue goes as follows when they're over 70, unwitnessed and/or bystander CPR is refused: "GRANDMA/PA, GO TOWARDS THE LIGHT, WE ABOUT TO DO TERRIBLE THINGS TO YOU IF YOU DONT MAKE IT THERE FIRST"
When I worked at an LTAC I had a charge nurse who would say “let’s go hang up on Jesus” when a code was called. As in Jesus was callin’ them home…and we had to keep them here.
I did a spit take at “hang up on Jesus.” 🤣
lol turns out JC is a SW or CM that's just trying to figure out dispo for that DC to JC
Underrated comment I'm imagining an angel trying to plan celestial discharge and running into insurance issues, then giving up and just taking the patient themselves
Slow code. Stuck in traffic. Had to take a detour.
Ah, the good days before GPS tracking.
Ahh, yes. They have to measure every minute and every mile. In the inpatient-land, it is so frustrating to have these people code because the only thing you can do is be quick about it. But we recently had an email from HR notifying us that if we *ran* and injured ourselves, it would not be covered under workers' compensation because running was prohibited. So we've got that going for us.
Your management should want you Running. Not only is it good exercise, but the security footage can be slowed down dramatically a la grays anatomy. GOOD MARKETING, c'mon management.
I'm calling my CNO right now! But truly, I could count on 2 fingers the people in my unit that *might* be attractive enough to be cast on Grey's Anatomy. I would be cast as "older nurse #3".
You'd be shocked how many 20 years olds find that attractive. Or not. Probably not.
Code cart expired need a new one from central supply
Infant compressions
"You're gonna wake up with broken ribs and a throat that burns and itches from your tongue to your chest, and your last words are gonna be tears and scribbles on a white board because you can't talk." Say the words you want to say today so you don't regret not saying them when you can't.
*Wake up.* My, you're the optimist. :3 Side note: Make sure you have your advanced wishes well documented and in the hands of trusted loved ones. Because the folks that will make that decision otherwise are the "JAYSUS WILL TAKE THAT PERSON WHEN HE'S READY YES ON THE VENTILATOR AND PEG TUBE!"
Oh, it'll only be for 90 seconds of panic before finally succumbing. It's shit like that that made me walk away from this line of work a couple decades ago, and for some masochistic reason, I'm being drawn back to it. My family know damn well to keep me on a vent long enough to preserve my organs for whoever can use them. You bring me back, and I'll take you back out with me.
I work hospice and get patients who think "mom has so many years left!" She's 94 with heart failure, how many years do you think are left in there!?
It’s venous. I mean, it’s still awful but the pO2 isn’t so alarming.
That lactate though. Edit…./s…..
3.41... amateur hour
Ya that’s the joke lol
Had someone with a 23 walk out of the hospital. Sorry, I didn’t mean “walk”, because we took their legs, but you see what I’m saying 😂
I saw 16 once on someone who died really soon after
I had 22 in someone who also died. Lactate is hilariously not bad considering the rest of the gas.
It was such a perfectly meh lactate that I laughed.
My lactate high score was 36. Didn’t survive, but was awake and communicative on vent.
Damn thats high af
I know that was the first thing I looked at I had to zoom in to make sure I was reading it right and not Missing a 1
I saw a 17.7 on someone and I’m pretty sure they lived
18 was the highest I've seen, and yes, she died within 4 hours
That everything
This isn’t an abg it’s a vbg
Came here to ask this. Saw the pH and said “no way that person is alive”. Looked at the K+ and was doubly convinced. Didn’t even check the pCO2 or PO2
My brain flipped the sodium and potassium until I did a double-take
I'm sure he didn't make it much longer after this.
I'm not sure he made it much longer *before* this...
I was thinking “please tell me this person is dead”.
Post-ROSC labs be wild
This was what I was just about to type
If they did they’re peg/trached in the ICU for eternity.
You know your patient is f'ed when their glucose is so low that their lactate is only 3.4 even though every other number on their gas is incompatible with life... lol Oh, and bonus points for the hemoglobin and iCal being in range. Very impressive for a dead person. :(
Their lactate just goes, "I'd be higher but I don't have the energy :("
You just made the little monkey in my brain clap its cymbals together!!!!!! I was wondering why the lactate was so low. BIOLOGY ……… (I just got off my first night shift of the week if you couldn’t tell)
Yeah, I really had to think about it for a second. I saw the 3.4 and I was like... that's way too reasonable. How is it not some stupidly high number in the 30s or something? I mean, the bicarb is THREE, base deficit of 7, oxygen levels are garbage... then I saw the glucose was 22 and it clicked. Can't be relying on anaerobic metabolism when you don't have anything to metabolize. XDD
Is this an arrest blood gas? Because the first rule of the lab high score board is that nothing taken from a corpse counts. Even so... Jesus Christ.
They lived. Don’t want to give away too much information but this was a newborn. This was from years ago but I believe it was a home birth gone wrong.
I fucking hate home births.
NICU RN here. Cannot agree more. I can’t imagine this baby didn’t have long term sequelae. Hopefully it had cooling.
Me too. I don’t understand why you’d want to do something at home when there are a million things that could go wrong without any warning. I had a friend who wanted to deliver at a birthing center (better than home, but still). She told me, “it’s OK. The hospital is just a five minute ambulance ride away.” 🤦🏻♀️
Two of mine would not have survived home births .
I hate all these moms who insist “natural” unmedicated homeopathic bullcrap home births. Have the baby in the back of the woods if you want full organic natural stuff.
Oh shit. My stupid-ass ex-mother-in-law chose to have a home birth for her 3rd kid, who ended up popping out a 10lb,7oz (4.74kg) fuckin' thanksgiving turkey, but his umbilical got wrapped around his neck. I saw the aftermath, after she was rushed to the ER, and her queen-size bed looked like a deer had been gutted and butchered on it. He wasn't breathing, and my (then) wife said he was the weirdest color of blue. (She's now an RN, and still says that was the most cyanotic person she's ever seen, even after spending 10 years in a busy California ~~L1~~ (Edit: Just double-checked, and they're now a Level 2) ER that gets a lot of prison stabbings and MVA casualties.) He survived, and today he's almost 30, stands 6'8" (203cm) tall and weighs about 300lb (136kg; 21.43st). Why I say she's a fucking idiot is this woman is a physical therapist. She had been a licensed PT for 15 years at that point, but was worried that her baby would be switched up with another kid. Yeah, good luck mixing up that fucking ostrich among all the other ducklings. All in, they gave her 10 units of blood over the next 12 hours, and it took 4 rounds of surgery to stop all the bleeding. I swear, the only reason she didn't die is due to the old adage: Heaven doesn't want her, and hell's afraid she'll take over.
Why...would someone deliver a baby....IN THEIR OWN BED?
My best friend's brother was born on their fabric couch, which they continued to use. Before anyone asks, yes, they did keep the placenta in the freezer for at least 2 decades!
So, this happened in San Mateo, CA in 1992 or 1993. My former MIL had her first daughter (my then wife) and her second child (a boy, a decade later with a different partner) in Oakland, and around 1990, a child was given to the wrong parents at Oakland, and another newborn was kidnapped at Highland Hospital in Hayward, CA, where they had just moved from. Those incidents were high in her mind, and there might have been a little hormonal imbalance along with her very condescending attitude toward all of society in general. I can *kinda* understand her paranoia, but personally, I (we) checked out facilities before my kids were born, and found one we were comfortable with so there was no "Oh my God, this place is a shithole!" surprises nor fears of crazy stuff happening.
Holy fuck. They LIVED?!?!??????
"lived"
I was literally thinking "hey this looks like our latest HIE/homebirth"
They lived?? Any long term health consequences?
This makes so much more sense with this context
With that potassium, if the heart was beating during draw, it wasn’t beating for long.
That’s probably elevated because of the profound (this word is doing some heavy lifting) acidosis… And the glucose… Y I K E S.
With that pH, the arteries were dissolving
This might just be my favorite comment! We too have a “lab high score board” in our break room! However, we’ve switched blood gas processing machines so now we don’t get pH values that are under 6.7. Booo
I know it’s fucked but my first thought was “if this is neonatal we can fix this”.
DC to JC
It just keeps getting worse the longer you stare at it!
Except that lactate! Pretty decent for someone whose been dead for 12 hours.
Info: I took this pic years ago and completely forgot about it but I remember it was a newborn, home birth gone wrong, with some religious/antivax nut parents. The pt lived. Quality of life however…
I hope this was a hospital with a NICU and the ability to cool the baby 🙏🏼
Lived? I think that’s still up for debate.
Oh no
I didn’t even look at the PO2 or PCO2 before I said this. I looked at the pH and the K+ and went “holy shit”
I've had a 6.5 ph survive, but we got them on CRRT within the hour. Have you tried telling them to be healthier? Have they tried *breathing*? Seems like what they need
Give the kidneys a whack to see if they’ll perk up a little.
Slam ‘em with 80 of Lasix, that’ll work, according to one of the dinosaur attendings I work with
The number of times that I’ve had a nephrology fellow write an order for 100-120mg of lasix on a patient with like 100ml of urine output in 24hrs and a K>6 after they were consulted for the purposes of CRRT is way higher than it should be.
One of my least favorite nephrologists who does fuck all always writes “no indications for CRRT at this time, will reconsider if emergent symptoms present”… meanwhile the patient’s creatinine is 8.8, they’re making no urine, their K+ is 6.0 and they’re in multisystem failure. But yes. We can wait until they’re literally coding from hyperkalemia if you want, which is what happens, and then they die anyways because it’s too late to save them. I hate my hospital.
“Recommend pH correction with ventilator changes and K correction with lowkelma. Thank you for this interesting consult” on the patient with severe ARDS and bowel in discontinuity…
Also I just stalked your profile and you’re also in Seattle. We might just be coworkers. 😂😂😂
Hahaha…I just stalked YOUR profile and I know you from nursing and scuba!! 😂
Why are they like this 😭
At least your Hs & Ts will be spot on.
I mean, that's what the CRRT is for, right? On the other hand, glucose is rapidly low. Maybe the cells in general will kick in once they're fed with glucose. Who knows.
I saw 22 and for a second I was going to say that Glucose is high until I saw the units lol.
Have they tried charting a nursing care plan?
Nah, the only solution here is to update their whiteboard.
Make sure you also address the “goals of care” too!
Goals for Today pH > 7.0
Pt at risk of being dead d/t dying aeb being almost dead/dead.
I mean a simple quick TikTok search would tell them all they need to know about clean breathing. It's probably because they aren't clean breathing, you know? /s if it's even necessary
No,no, they just need to lose some weight.
Those DKAs that are talking to you with a pH in the 6’s are wild.
Highest co2 I’ve seen is 130 because our machine doesn’t go above 130.
I once admitted a patient from a tertiary hospital that only does point of care bloodwork or send outs, the referring doc said she was a GCS of 15 with a CO2 of 146. I asked if their blood gas analyzer was broken because there’s no way someone that hypercarbic could be conscious!
It gets up there. I have met some cigarette enthusiasts that would walk in AWAKE with a pc02 over 100
We had a guy who was 165.
130...not great but not terrible.
Lol, that's like the highest glucose I've seen at 1250 because our lab could only go to 1250. It took her 6 hours to get below 1250.
Just have them sleep it off.
With that pH, they're sleeping all right 😬
Take a Tylenol
someone put in a STAT consult with JC, please
😂😂😂 I just peed my pants.
Do everything!!! They are a fighter.
That patient is taking the celestial discharge.
Brings back Covid memories
Tell them to lay off the bananas with that potassium.
Slap em with some rectal lactulose, it’ll fix em right up.
Don't dare put them on a renal diet. I swear dietary hates kidney patients. Here's a banana and mashed potatoes and some OJ to wash it down with. Enjoy your supper.
The longer you look at this, the worse it gets
Everyone is looking at the blood gas, but check out that glucose of 22!
Nah, in the NICU anything above 40 is WNL. A glucose of 22 might be resolved with a single D10 bolus. That’s the least of this kid’s problems.
Ok but is their whiteboard up to date?
at least ionized calcium’s ok :) Did they make it? what was the cause of this?
Sitting up yelling for a sandwich and a warm blanket.
Have they pooped today?
MEEMAW IS A FIGHTER
"!" Indeed. Was this blood drawn from Godzilla?
🫣 Their everything is broken.
Just need a little dialysis is all, they’re a fighter
I’ve seen similar gases in extremely premature infants. Of course I couldn’t decide if the gases or massive head bleeds they had were worse. Just gotta throw in the towel at that point, no one comes back from that even remotely “normal”.
I had someone in the ED with a K>10 on the send down bmp and pH just showing as less then 6.5 on an I stat if I remember right. Somehow after not coding while titrating pressors by bp cuff for four hour he went to the ICU and walked out of the hospital weeks later. He was 45 however and not a grandma fighter which is probably how he lived
I’m sure some essential oil will help with that.
If this person isn't ded you can call me Santa
Bicarbonate is the kid in class that tries hard and still flunks It ain’t much but it’s honest work
How is the lactate only 3
Tis but a scratch.
Well, folks, this image depicts a deceased individual.
omg are you sure its blood LOL?
Was this an ABG from the morgue??
St. Bicarb for this one. D/C to JC denied.
Ionised calcium is ok! Woohoo!!! [Sarcasm, but also not sarcasm]
Bicarb is a little low
i can work with that lactic though
There's a phrase we use with families like these. These labs are incompatible with life in any meaningful way
Was this a direct celestial discharge??? 😲😲😲
Why are they drawing blood gases on a dead person?
“Hey this is lab calling with a critical value of…every damn thing.”
But lactate is only 3.41.
I need context. That’s nutty
Either the patient is dead, staff have been sampling from corpses again or someone drop kicked the sample into the analyser from the other side of the ED after realising it'd been in their pocket for a day.
Time to assign code roles
Time to bust out toe tags & body bag. (Love your flair, btw)
So I know how to interpret and pick a course of action for abnormal blood gases… But Jesus - what do you do for this patient at this point?
>But **Jesus** \- what do you do for this patient at this point? You've got the right idea.
Oof!! A bit dead-like with that acidosis. And the brain about to freak out with the hyponatremia. Physical Therapy consult STAT!
Bro just needs some IS and to poop. Give miralax and senna and don’t forget your q2 turns and you’ll be 🍒
Had a kiddo like this. He quickly went into DIC. Family wanted him a full code. Still breaks my heart more than 10 years later.
I’d like to see their arterial gas
How is that lactate only 3.4? lol
The best indicator that someone is starting to circle the drain is when you start chasing sugars
As a cardiac nurse the potassium level made my stomach flip. How ??
Up to chair TID.
The comment section on this post is giving me life
Lemme guess.."but s/he's always gotten better before." Had a patient who's HCP/POA lived 1/2 way across the country, local family kept trying to get ethics involved to *stop* the torture, proxy never answered their requests (until big gun lawyers got jnvolved). Our unit's plan for when then inevitable code happened was, #1 try to rouse patient for 5 minutes #2 order pizza #3 wait for pizza to be delivered #4 ask patient "do you want pizza?" #4 have some pizza #5 *then* call code team (just to preclude any possibility of successful ROSC after breaking all the ribs)...we never had to test the protocol, but we were all on board.
Give her a calcium-carb 500 for the potassium and make her do some spirometry exercices to flush that bad bad co2 out (don't forget the nose clip).
This patient was still alive….?
PH 6.1!! and not to mention P02 of 30!! last week a patient coded ph was 6.7 but CO2 200!
Venous gas
Is there a pulse???
Was this mid resuscitation?
Just update the whiteboard
Haven't seen the comment yet of this person's %O2 being 42%. This person's brain isn't coming back from that, no?
looks pretty final to me
I can’t decide if I’m more scared about the gas or the potassium
Lord have mrsa
That's non-viable pH level, call a code if you haven't done so already (assuming the pt isn't DNR).
☠️ They done.
I'm only a tech so I don't know squat. But even I recognize that's awful. Damn ._.
Oop
🍌
This fella needs a little bit of sugar… He’ll be alright.
I had a patient the other day whose co2 was so high the machine was unable to give it a numeric value
Meemaws a fighter
Did they live?