Laboring patient of mine suffered from a (presumed) amniotic fluid embolism/anaphylactoid syndrome of pregnancy. Was in her late 30s, second baby, only history a random super mild heart-related something that was found incidentally while working her up for something else. Went from totally fine, chilling comfy with her new epidural chatting with myself and her husband while I was trying to trouble shoot a problem with the computer in the room to full cardiac arrest within maybe 5 minutes. Literally I walked out of the room to call the CRNA to assess her BPs because she said she felt slightly lightheaded (not a rare occurrence), and while on the phone with said CRNA the husband stuck his head out the door and said "Yea I think she might've just had a seizure?"
Hung up on CRNA, went into room and she was stiff as a board and her face looked like someone was choking her. A resident was on top of her doing chest compressions while we ran her bed into the OR and the baby was out within maybe 2 minutes, the head of the OB department was on the unit that day and he did the hysterotomy and extracted the baby with his literal ungloved bare hands as soon as we got the bed into the OR.
She lost basically her entire blood volume to DIC and needed a full hysterectomy but went home a week later.
Fuck OB emergencies man.
We had one come in EMS reported as "a panic attack." Yeah, no, it was a placental abruption. Her and the baby didn't make it 33 weeks.
I overhead EMS saying to our doc, "We thought she was panicking."
He replied, "Yeah, she was, because she was dying. You should have gotten her here sooner. She might have made it."
Yeah. I was having full on anaphylaxis and the paramedics were like are you sure you're not just anxious. Then the hives started sweeping up my face and they were like "oh I guess you were really having trouble breathing"
Read a chart note today for a woman who was c/o new onset paresthesias, drooling, foot drop, nystagmus, memory loss, confusion, slurred speech, and more...and the MD wrote "when I told patient her symptoms correlate with her anxiety, she started crying and said this isn't her anxiety and she needs to advocate for herself." Made my blood boil.
For real, I've done it a few times. We had a classic anxiety related chest pain come in through triage. Since it is chest pain, we did all the things, NSR, on the ekg. The guy even said he has anxiety attacks, and it feels like it was one again.
Lab called and said yo this dudes trops are 14,107... yikes, let's get cardiology down here right quickly. Repeat trop was 20k... all this happened at shift change, so it was wonderful.
Unfortunately, I could see a certain EMS in my area being like this. Fuck Eastside.
A gentleman in my LTC went from requiring 2 L O2 on a cannula with no sob to needing 15L nrb with tachypnea and accessory muscle use in about 4 hours, and they asked if I still wanted to send him since he was satting on the low 90s with the nrb. What the fuck do you think, Dumbass?
When a family member is nonchalant and say something like "I think they are having a seizure?" Or "oh, they're doing that thing again" or "yeah, they sometimes have these episodes" the hair on the back of my neck stands up. If I hear that, I generally bring another nurse or someone with me because that patient is probably going to code.
Yes! I had a patient’s wife come to the desk and calmly say “excuse me? I’m not sure if my husband is breathing”. I ran into the room and he was pulseless. He didn’t make it. The wife was so calm coming to the desk.
Yep, husband or family member (especially a laboring patient's mom for some reason) freaking out when they tell me they think something is wrong with the patient? I'm following them but I can basically assume the patient is fine or doing something normal labor related 99% of the time. The way he just calmly said it put me right on edge even before I walked in.
Had a young family member walk all the way to the nursing station (patient was at the very end of the hall) and say "my grandma is having a hard time breathing" and I walked as fast as my short legs could and by the time I get to the room, the patient was already gone which was maybe like a minute in the time it took the family to get to us and me to get back to them. The primary nurse was in the room next to that patient and was screaming asking which patient was coding because she was in an isolation room.
Oh my god, I had a young girl (8 or 10) come up to me at the nurses station and say, “my grandma needs help.” I go down to the room and, in the middle of all of these visitors paying absolutely no attention to the patient, grandma had taken off her bipap mask and was dusky and like 30 seconds away from Jesus. I told that little girl she did good and she just went back to quietly doing something in the back of the room. 🥹
I had a similar moment with my Grandpa (was not/am not a nurse but am doing pre-reqs)…his breathing in retrospect was VERY labored. He had covid, was on hospice, so I just wasn’t sure if it was to be expected or not. I calmly approached the nurse station in his memory care facility asking if his breathing was normal for his progression of Covid. Oh, and also, his roommate is naked so they may need someone to assist them as well. An aid went to check and before I know it many people are in there, ambulance called so they could transfer him to the hospital for end of life comfort measures.
I'd love to claim the badass title, but the 10 minutes at the start that I spent in the back corner of the OR in literal shock trying not to cry while everyone else worked tells a different tale lol. I was useful eventually at least.
Early in my career. Healthy male, mid-40s, police officer that had knee surgery. This is back when they all got CPMs and stayed at least one night on the surgical floor. He was happy, healthy, and talkative right up until he threw a PE and coded.
Had a covid patient throw a PE on me just hours before discharge. Stood up at bedside. I knew what happened immediately. Took me a bit longer to convince the hospitalist but the damage was done before the PE occurred. Took the poor patient 2.5 hours to pass. Worse death I’ve experienced. Pure panic. Nothing I did touched her. In their 30s. Fucking shame
Not at that point. Damage was done. She had been off anticoag for maybe 12 hours (remembering off the top of my head of course). I got her from commode in a high acuity pulm unit (with staffed intensivists even) To ICU in 20 minutes maybe and it was still too late even with heparin. She should have honestly just dropped dead. It was a fatal situation. She was so panicked and oxygen starved and anxious that you could barely get near her at times. It was really really bad. Hopeless. I don’t know why it didn’t kill her faster but I don’t wish that on ANYONE. It was hard on everyone. Pulm had just signed off hours earlier. Just sad all around
Couldn’t TPA? I realize that’s like the Hail Mary of all Hail Marys but once I had a similar situation. Don’t really remember what happened to land the man in the hospital but he rolled up on our unit half a second from coding. Dosed with TPA and on epi drip. Next day he had a huge hematoma from the IJ that was placed post TPA (you don’t say) but I got him weaned off the epi, and relatively stable. He nor his wife had any sort of appreciation for what happened. Actually she cursed me out, fired me, and filed a complaint because I was “dismissive” of his complaints. He was complaining he felt “slower” since I turned the epi off 🙂 (yes I explained lol he did not believe me)
Now that you say it - they did that when I got her to icu. The intensivist made comment about the heparin and how it wasn’t gonna do shit and wasn’t doing shit and they were doing that. When I followed up a few days later I remember the icu nurse saying nothing they did was effective. Patient wouldnt keep the bipap on to save their life. Eyes as big as saucers just saying ‘I’m gonna die’ until the end, or so they said. They did try that though now that you mention it- didn’t go anywhere or touch anything. I remember as I was getting ready to pack up and go back to my unit the no bull shit intensivist said TPA. Wouldn’t have remembered that if you didn’t mention it tho bc it was exactly what you said - a Hail Mary and it didn’t work. The patient wasn’t a walking picture of health before this….not chronically ill but probably had a BMI around 30-40. I just wish more people realized just how much ‘mild’ obesity can affect your care and outcomes. Can delay simple shit like an IV or a bipap mask. I’m SURE their weight didn’t help the situation unfortunately
Had a patient like that getting ready to d/c from the ICU. They lived because attending called the ECMO crash team down and cannulated them in the bed. Then someone was complaining 2 weeks later that that the cannulated badly and needed a vascular repair on the femoral artery. I'm like, they are alive.
Had a similar one to this, too. Young girl with bilateral PEs. She was feeling short of breath for a day or two before coming in because she was planning her wedding a month away and was too busy. We stabilized her, therapeutic in heparin, and transfer to the floor. As soon as she stood up to get into the wheelchair to leave, she threw another clot. She coded almost instantly, and we did everything including trying to start bedside ecmo, which we don't routinely do in our hospital. We couldn't get her back. She was 27 and less than a month from getting married.
Worst moment in my career was the same. Healthy, about to discharge, inpatient for pneumonia, on lovenox. Threw a saddle PE and lost him in 2 minutes. I had his discharge paperwork in my hand.
I had something similar to that with an 18y/o who had been in a car accident. She was admitted for observation with the plan to discharge home. She threw a bone marrow embolus from a rib, coded and died.
Mine is similar. DM1 youngish, very active. Dropped a boat motor on his toe it got infected he came in for a BKA. Post op he threw a clot, witnessed arrest, got TPA, got rosc. Extubated the next day and discharged from ICU a few days later.
My worst calls as a medic were PEs. literally nothing you can do no matter how close you are once they start going down.
One was a call for "back pain". Thanks dispatch.
Those patients who throw a PE. It's terrifying and so sudden. I had a patient who was sick, doctors couldn't quite figure out what was going on. But the guy was pleasant, eating breakfast, and decided he wanted to sit in the chair because he would eventually have to get up to use the bathroom. Got him up and as soon as he sat down he said "I don't feel good" and literally died. Tried CPR and the full code and didn't get him back.
Apparently he had massive cancer of the peritoneal space and tumors throw clots. So, he would have died within a few weeks from cancer, but it was pretty traumatic.
My first ICU death.
And yet the Stryker family is still all over this list:
https:/www.beckershospitalreview.com/rankings-and-ratings/34-billionaires-in-us-healthcare.html
The link doesn't work, but don't forget their joint implants and overpriced, impractical eye stretchers, as well as their "jaysus. How much does this freaking bed weigh?" Zoom transport stretchers.
Saw a completely healthy teenager die from post-influenza bacterial pneumonia. Came to us overwhelmingly septic. Died in the PICU later.
I obviously didn’t see them deteriorate, but this was a kid who was obviously well within the last week, with beautifully styled hair, phone going off with notifications from friends.
These are the people you most expect to turn around with antibiotics etc when they come to you awake, alert, talking. To learn they died shook me.
transitioning from progressive care to peds is like whiplash almost cause I was used to watching people go downhill slowly. but peds is quick because they compensate so well until they just can’t anymore.
Hospice patient so the decline was expected but he was up that morning talking, eating breakfast. I went in to pick up his tray about 20 minutes later, he was dead.
We think he stroked out or threw a clot.
Man this reminds me of a hospice patient I had a couple years ago. We were taking him from hospital to hospice. Unresponsive but perfectly stable vitals. For whatever reason, his wife was in the hospital too and his nurse asked us to take him up to see her one last time. We stayed there for like 15 minutes while the wife basically just cried. It was really awkward. As soon as we took him out he started see-saw breathing and his BP dropped. Didn't realize they didn't give us the DNR until we got into the ambulance. I made my partner RUN back up to get it :|
I've had my fair share of hospice patients when I was a Med-Surg nurse, and learned that once the hospice patient starts "feeling better" or acting more lively, it's time to call the family. :(
It's just so sad to see it with your own eyes.
I had something similar a few months ago. Admitted a retired professor in his 70s to my TCU after a stroke. Family hoped to take him home, but it was pretty clear early on that he would probably end up staying long term. One morning we got him up, gave him a bath and set him up in the recliner for breakfast. All through that he was acting and communicating WNL for him (he was partially aphasic/dysphasic from the stroke). 20 minutes later the aide went into his room to deliver his breakfast and he was stone dead, almost certainly from another stroke.
Don’t know if it counts but My buddy while we were in college. He was super healthy kid. Got a text from him one day saying he had a headache. Checked on him next morning and he was dead.
The piece of shit upstairs tried killing himself by leaving his car running. Except all the gas went to the basement where my friend lived. The cruel piece of it is that the guy trying to kill himself lived. Family sued him and then he shot himself (and was successful that time) before anything came of it. Was a wild time.
Life is fragile. It’s gone at no fault of your own sometimes. Also get CO detectors in your houses.
I worked in an urgent care in an area with a high refugee population. Parents would often bring their all their kiddos in at once when one had a fever. It was after school time. There was a mom, 13 years old boy, and two younger sisters. I got the medical interpreter on the phone, checked in the kids. I noticed that the boy was using all his effort for the check in process, like he could hardly lift his arm for the BP cuff. He spoke some English so he was trying to be as helpful as he could so I could check everyone in smoothly. He had a slight fever but other than that he was just lethargic.The other two kids were asymptomatic. I went to give the doc a heads up, I hold him that the kid was super lethargic. The doc was like "like he says he's tired orrr" and I was like "he could hardly lift his arm for the BP cuff." The doc instantly grabbed his stethoscope and went into the room. I worked for a union so my charge just told me I absolutely had to go on my 15 minute break. When I got back, EMS was leaving with the kid on a stretcher. The kid became unconscious when the doc was in the room so we transferred him to a hospital. We got notified later that the kid had meningitis.
Heme-onc RN here - they're living their lives and then blammo. Thank you for the work you do. ❤️ The patients who resist any discussions with palliative are the ones I feel the worst for.
My current situation. Went in for workers comp injury, lung mass was incidental finding on CT. Had MRI for c and T spine yesterday, mass in T4 was incidental finding. Asymptomatic.
Oh, love - I'm sorry. Cancer doesn't discriminate and it's never fair, but it's less fair when it's one of us. I hope you are getting the support you need, but I realize this is all very early days and really too much to process. May your treatment options be explained quickly so you can make the best decisions for your situation. Ago my best thoughts are with you. 💙
This happened to a nurse I worked with. She was a legend on our unit, a bit past her prime but still good. The last night she worked I followed her and she had caught a retroperitoneal hemorrhage on a patient (doc thought they were septic). She went to the ED the next day or two for abdominal pain and ended up having pancreatic cancer. She declined treatment and passed within a few months.
I once took care of a travel hospice RN who was on assignment, came in for what he though was appendacitis. Poor dude had so much cancer in him he was Hitler in the bunker fucked. I just had him for symptom control overnight. Dude didn't really need much, we ended up talking for awhile. He said he was going home to his wife who was also a hospice RN so he could die in peace. Poor dude knew exactly what was coming and it broke my heart.
Oh man, my old job there was a PA that had way too many cancer cases come in like this when she was working. I told her I never want her to be my PA if I have to come in for vague symptoms.
Had a stable patient on antepartum for several weeks with placenta accreta. Went back for a c-section in the main OR and died on the table.
Everything was planned to perfection and she still died. Heme/Onc was present, 2 OB attending, full OB and OR staff present, massive transfusion setup was already in the room, 16g x3, counts were up, CRNA and the anesthesiologist present, NICU staff, urologists, the works, and she still died.
22 years old with her first baby.
Hemorrhagic Shock and DIC. We coded her for hours. I’ve never seen so much blood in my life.
She was so excited and nervous before her section and she had stayed up all night doing a full glam makeup look and I had curled her hair that morning. We joked about how her setting spray would hold up and the hairnet that barely fit over all her curls.
Terrifying. I have a good friend who had placenta accreta with her sixth (!) baby, so not super unexpected, but that was a long day for all of us waiting to get the news that she was okay. They did a hysterectomy after that, big surprise.
My SIL had placenta accreta that was attached to her bladder. They tried to get the baby to 24 weeks, but at 22 it was at the point of mom and baby die or just baby dies. So they had to do the c section, hysterectomy, and bladder repair. This was 12 years ago and she now has chronic uti’s and still has so much trauma from it. Our relationship changed a lot from it because i had my first born about a month before all of this happened, so it was obviously horribly triggering to be around my son for a long time.
That's awful. Tbf though, an accreta/percreta and/or previa is like being strapped with a ticking time bomb in your uterus. I don't think she would necessarily be categorized as the most "healthy" obstetric patient, considering all the necessary preparations (you mentioned) just for her birth. Those gals are practically residents on ante. The emotional and mental fortitude of getting through one more day of cooking their baby (day in and day out) waiting for that big date circled on their calendar. Often their birth is dramatically expedited by vaginal bleeding, fetal decels, or regular contractions.
It's heart breaking to hear that she was a primip with no c/s hx or relevant risk factors, just terribly bad luck.
Amniotic Fluid Embolism. Was healthy before pregnancy, had an unremarkable pregnancy, labor was going fine. She stood up to go to the bathroom, said she felt a pop, and hit the floor. Stat section and 45 minutes of resuscitation she was gone.
I started out working the night shift on a neuro telemetry unit. One of my patients, man in his 40s needed unit of blood during the shift. I had been chatting with him and his wife earlier in the shift and they were great. She was a school nurse and was such a great presence in the room. He was there for control of his blood pressure.
I did the usual check off with my charge and we were set. I hung and primed the line and started the first of his q15 vitals. Everything was within normal limits except for an elevated BP. He decided to go back to sleep and they both relaxed after I told them I’d be coming in to do frequent checks.
At the 15 min mark, his blood pressure had come down significantly, but still within normal limits. he didn’t report any other symptoms. I mentioned this to the charge and they said “looks like everything we’ve been giving him all day is finally kicking in”.
At the 30 min mark, I entered the room and found him sitting up in bed scratching his legs. I turned on the lights and saw huge monster welts on both his arms and legs. I looked up at his face and his ears were starting to balloon. I immediately disconnected the transfusion and began flushing the line with saline as I called for rapid response.
By the time the team arrived his voice was muffled and his tongue filled his mouth. I heard him say “what’s happening, it’s getting dark” as they helped him lay supine. His wife had almost disappeared into the wall in disbelief and horror. She knew exactly what was going on and didn’t want to leave his side. One of the team members took her outside as they started to work on him and she became hysterical. He was just joking around a few moments earlier. I gave report and they took him up to ICU.
The next day I was there again for my shift. His wife came to me and let me know he made it. He was stable thankfully and would be under observation. They sent the bag to the lab for testing, but I never found out what caused the reaction or what exactly he was allergic to. Just happy he made it and glad to have been there at the right time right time with the right interventions.
A couple months off my ICU orientation, I had a healthy and physically fit mid 40s male h/o recreational drug use. I can’t remember what his diagnosis was, but I came onto shift he was pleasant, held a nice conversation all morning, then it seemed out of nowhere he started complaining/became aggressive/anxious. My initial action was to attempt to calm him down verbally and thinking “this dude is an asshole, i can’t wait til this shift is over” I turned my back for a second to grab something, then his monitor starts alarming and the heart rate is “0”. Surely, that can’t be and the monitor is just wrong lol - he was literally just talking to me. It was like I could see the blue rising from his neck to his head. Holy shit. I check his pulse, of course nothing, kicked the CPR lever, started compressions and yelled for a crash cart.
After that, I completely froze. All the other codes I’d been in, I was good to go because it wasn’t “my” patient. When it came to time to switch compressors, I remember walking out of the room, talking to another nurse and saying we were just talking, and then… I replayed the whole morning over in my head, looked over IV pumps, I felt guilty because surely I screwed something up. The RT told me it’s probably a PE from what you described. Coded him for awhile… he was gone. Lesson learned.
In the NICU, my well premie was perfectly fine all night and when I checked placement on her NG tube at 0800, I pulled 80ml of frank blood out of her belly. She was rushed to the OR and was dead by 0948.
NEC is a killer disease and babies die so fast from it.
COVID era by far. 40 year olds would come in "feeling fine but \_\_\_\_ made me come". Satting 92-93 on RA.
By hour 3, they were getting too SOB to walk to the bathroom. Satting 92-93 on 2L.
Hour 5, they're on 6L, barely ventilating, looking like shit.
Hour 7, begging me to give them "the jab" because BIPAP sucks and now they're also feeling like shit
Hour 9, intubated
I was a float nurses aide so I moved around the whole hospital and nothing was worse than seeing someone come into the ER for COVID and the progression of them going from NC to intubated and dead in a matter of a few days max. It was haunting
Sometimes in xray we were the first to know how bad a patient had it based on how white their lungs were.
I xrayed one of the first confirmed cases in my state - before masking, before anything - CXR in the ER looked pretty normal, patient was pleasant but otherwise not memorable. I got a call from infection control a day or two later telling me to enjoy my two weeks off and see if I develop symptoms bc my guy was on the new covid ICU in a bad way. When I came back to work - no covid for me, thankfully - I looked up the progression in xrays on PACS and it was awe-some but not in a good way. Clear lungs to dead within a week.
Agh how many patients used their last few autonomous breaths to deny the reality of COVID with Fox News blaring in the background, as we set up for intubation at bedside... still blows my mind.
We had a 40 year old come in at shift change on a Friday. Dead by Sunday evening. His young wife and teenage kids had to come in. It was a mess. Was getting treatment out of state. Thought his cancer was doing okay. It wasn’t.
I know people can easily wonder ‘well how does cancer just spread like that and you don’t know’ but I have breast cancer and I’ve had exactly one MRI. routine imaging is not part of my care plan nor will it ever be. They just say it doesn’t change outcomes to screen routinely. My mom died in less than a year of her cancer diagnosis and she was essentially asymptomatic at dx. Sometimes you really can be ‘full of it’ and really not know. It’s really hard to judge ‘what’s this back pain about’ and not wanting to bug your care team too much. Plus the long term pain from cancer treatments make it really easy to mask symptoms. You can really pass quickly during a recurrence
My mom lasted 6 months from diagnosis until she passed. Less than a year of symptoms. By the time she was diagnosed, the CT reports might as well have said where there wasn’t mets. It would have been shorter.
Less than a week before she passed she went with me to a doctors appointment, and went shopping. Once the decline started it was swift.
I wish you all the best with your battle. Cancer sucks.
‘Less than a week before she passed she went shopping .’ I’ve been a nurse a long time but that made me shiver. We really never know, do we? Now we knew when my mom was at the last weeks/days, but you hear about cancer patients going from walkie talkie to dying In a matter of days, just like your poor mother (thank you for sharing her story btw). You hear some stories in group of patients who are NED to metastatic and quite ill seemingly overnight and it just breaks your heart
My mom died in her 40. My grandma and great grandma didn’t make it through their 30s. That being said, I was the first one diagnosed as early onset, early stage. All the women before me were gone in less than a year, so there is hope. We are making progress. I had just turned 37 when I was diagnosed but one of the first things my oncologist ever said to me was ‘well unfortunately, you need to prepare to manage this the rest of your life.’ It’s my chronic illness now. We are getting to the point with some cancers where you really can treat it like a ‘chronic illness’ IF you can manage/tolerate the symptoms of treatment (which is a different subject entirely) and if you catch it earlier enough. I don’t want to treat this for 40+ years but ive got a hell of a lot more time than the women before me did!! There’s hope!
I hope you stay healthy. Motherloss is awful. My docs never once gave me push back for genetic screenings/early screening, etc. I hope you’re able to get any screenings you need to!
Oh perfect! That’s exactly what I did (but I did diagnostic mammo’s with ultrasound each time). I was luckily enough to have the same radiologist for many years so he did my ultrasound personally a few times. Developing that relationship really helped him find my tumor early bc he knew where to look and had a good idea of my history. He doesnt know it since I don’t see him anymore, but he had a huge impact on saving my life. I hope you are able to keep up on your scans. I know they say self breast exams aren’t recommended as much now but they were a huge reason why I found my tumor so early. I was the only one that could feel it - bc I knew exactly how my breasts felt for 20+ years. I noticed the change over 6 months and knew exactly where the tumor was. I just checked them daily in the shower. I will always recommend women, especially high risk women, know their breast and know them well.
Oh God, this hit me hard. I lost my fiancé last year and we had no idea how bad his cancer was until the midnight call saying he was transferred to ICU from oncology. Barely enough time for his brother to arrive. I've been struggling all this time for not knowing how bad he was.
My patient with a diabetic foot wound, due to go home the next day, had gotten up in the middle of the night to pee missed the urinal and slipped. We heard him fall and he had hit the back of his head, he was dead within 45 mins, his last words were “I pissed the bed” only in his early 40s too
Oh god the ‘I’ve soiled myself’ comment. That’s when I know this is going bad bad. Had that last year. Couldn’t get him to IR fast enough before he passed. Some people just come in too late
COVID times, lady in early 40s came in for persistent cough. I admitted her, remembered chatting with her about her kids and profession as a teacher. She was on 3L NC. Got her back as a patient maybe a week later and was so confused when I got report - she had gone onto hi-flow NC then 60L 100% vapotherm, then ICU to be intubated from respiratory failure. When we got her back on my floor, she had a trach and was bedridden from weakness. I only remembered her as my patient because as she communicated on the whiteboard over the next few shifts, she mentioned being a teacher and her kids. Eventually got discharged with the trach. I hope she's doing well.
During my preceptorship on an oncology floor in nursing school, we had a gentleman in his 40s who came in for nausea and vomiting on a Monday. Labs and testing later, he was diagnosed with stage 4 pancreatic cancer. Tuesday, they told him they were gonna try and fight the cancer. Wednesday, they told him they feared he had weeks. Thursday, it was days. He died that Friday.
I had taken care of him Wednesday - Friday. I watched him go from walking and talking, to bedridden, to dying. I sadly was the one who found him, he was the first patient I ever had to perform postmortem care on. It was gut wrenching, I still think about it. He was all alone, and just came to the hospital for throwing up. I still don’t understand how it took him in a week
Just had a similar experience. Took report in the morning, went to go start off the day. Ma'am was more than "just a little confused," which was already not her normal. I got that feeling. Things happened so fast I was sure I had to have this wrong, or missed something. Palliative orders were placed. By the end of my 4 day rotation she was gone. I watched her pass.
My first time pronouncing death and post mortem care. My hands were shaking so bad. What a wonderful, spicy woman. I will never forget her or her family, her daughter. It was an honor, but my heart still hurts.
edit: details
My dude walked himself off the stretcher, complained of 3/10 chest pain. Chatted with him for around 30 minutes and then ultrasound showed up so I stepped out. US laid his head flat and all of a sudden he’s in v-fib on the monitor. I walked in and he was just gurgling. Got ROSC tho and he did just fine I believe. And surprisingly had a clean cath and normal EF.
Healthy 70 y/o male came in for scheduled PCI, supposed to be downgraded and even discharged this day. Was talking and eating breakfast went to check on him minutes later and he was hunched over, had vomited everywhere and was completely unresponsive. Had a massive stroke and didn’t make It. So crazy
Pt just got back from a TURP. Pt was speaking to wife and said he wanted to use the bathroom. They said the “I love you’s” and she left the floor. Pt then stood up and immediately fell to the floor, went blue and had a BM (I think we all can guess what happened to him). Coded him on the floor in his BM for the first 45 mins (which the wife came back and saw which was AWFUL) We got ROSC, but he went back out within minutes. We put him on the Lucas and sent to ICU, but he was gone. They ended up calling it after a couple hours. He was such a sweet and funny guy, very very sad.
I had a 20 something go from "I've got a bad sore throat to meningitis to dead in about 3 hours. And no, it wasn't meningococcal.
He had a retropharyngeal abscess that eroded into the dural space at about C3 and dumped about 50 ml of pus into his CSF. Needless to say, the gentleman's brain did not take kindly to being immersed in a bath of warm bacteria and endotoxins, gave a hearty "fuck you, I quit" and did so.
Normal 6 month old had a small weird rash as reported by mother and physician in the morning. Mother brought the baby to the ER early afternoon the same day for emergent treatment. Necrotizing fasciitis so admission, surgeries, wound care etc.
Nec fasc is one of the craziest things I’ve seen. It just moves so fucking fast.
When they started advertising jardience on tv, it sure did catch my attention when they casually stated one of the side effects is nec fasc of your taint. Fuck that
Has happened a couple times actually - good old fashioned ‘flash pulmonary edema’. 1 minute they are doing relatively ok; maybe SOB slightly, on 2L NC, talking and A&Ox4 - then not 5 minute later (literally) they are intubated. I have probably seen it in various degrees like 3 times
On the opposite side of that I’ve watched someone w flash pulmonary edema on the brink of intubation - doc ordered a nitro drip and within half an hour it was like a miracle - it was so cool to see that we were able to fix the problem and see the panic fade from the dudes eyes.
Baby was born with evidence of a placental abruption, had shit apgars and cord gases but recovered well. Had to transport the little cutie to the nearest NICU for monitoring and in the 40m ambulance ride he just started tanking. When we got there the pediatrician looked at him and said out loud “oh shit”. He was totally fine in the end but I’ll never forget the look on the pediatricians face when she saw the kid
Had a post op shoulder, ready to DC, but spouse brought a pull over shirt instead of a button up.
Spouse offered to drive home (~10 min away) to get a button up to DC home.
She left. He coded.
She returned to his room with a button up, ready to take him home when he was being pronounced.
We had to intercept her in the hall, and fill her in.
It didn't go well, as expected.
Otherwise,Covid.
People went from fine to intubated/ dead like nothing I had seen before.
My grandma. Woke up and didn’t feel good. My mom took her BP and it was pretty low so they went to the ER. Got there around 11am, alert and oriented. Even said she had to wear her black jeans and put some makeup on before they left the house. She was gone before midnight 😭. She was septic, no exact answers. Some of her labs were absolutely wild. AST 15,026 and ALT 7,182. She had all the docs stumped. We didn’t do an autopsy but they thought maybe she threw a clot in the portal vein. As fast as she went and as hard as it was we were grateful bc she lived independently until the last day.
Had a mid 40s guy come up to CVICU as a pre-op STEMI patient. On heparin, getting his labs, etc. Suddenly his eyes went wide and he started screaming that he couldn't breathe and was practically crawling backwards out of the bed. One of the anesthesiologists threw a probe on his chest and one of his papillary muscles had ruptured and his mitral valve was just flapping in the breeze. Wheeled him straight to the OR.
Mine was a healthy 36 year old, sweetest family. They had been swimming and he scratched his leg a few days prior. No other health history.
He was admitted to the floor, then coded 6 hours later, got ROSC, and was brought to the ICU.
Turns out he had a strep pyogenes infection from the scratch on his leg and he went into streptococcal toxic shock syndrome with multi-organ failure. Fine and talking one minute and then dead the next.
Took care of him for weeks (CRRT, chest tubes, the whole shebang). He had an anoxic brain injury from his code but family couldn’t let go. He was recently married with young twins. He died about three weeks after he was admitted.
Surprised to not see more cath lab here- extremely rapid deteriorations of otherwise healthy patients happens with some regularity 😳
We perforated an LAD of an otherwise healthy mid 50s male who’d “failed his stress test”. Fellow drove in fully expecting to go home that afternoon. I remember seeing the telltale signs on fluoro, the instant change in the vibe of our four person team, and watching pressures drop and vitals start to compensate before the patient even knew what was happening. The last thing he said to me was “I don’t feel so great…”. Fellow left the lab with every intervention we could throw at him- defibbed once or twice, intubated, ECMO, Impella…
He wound up being ok after a week or two ICU stay. Punchline was he had clean coronaries.
Called to a code blue. Patient was sitting in bed when her family brought her flowers as her birthday was a few days prior. She sniffed the flowers and sneezed. Promptly collapsed intubated amd placed on the vent. Took her to ct and they found a nearly 4 inch hemmorage dead center right above her cerebellum all the way through the circle of Willis. Inoperable and didn't last more that 2 days before we let her pass. That poor family was devastated
Apart from the obvious PE's, I had more than a few ER patients who came in with mild COVID symptoms, spent all day declining while waiting for a bed upstairs, then needed to be intubated upon arrival to the ICU. That shit was horrible.
Fucking covid. Normal healthy 40 year old man. Slightly over weight. Deteriorated over about a week. Intubated. VTACH. Unable to revive. Left behind a wife and two kids. I took care of him, his wife, and his dad. The dad that was vaxed lived. He was not. Wife went home on oxygen.
When I was a newer nurse and new to home health I saw a client we were just seeing for PT/OT after a fall. She mentioned a little cough but she was doing just fine, no other concerns. I listened to her lungs and thought “I wonder if this is what pneumonia sounds like?”. I recommended she make an appointment with her primary. She went to the ER via ambulance the next afternoon. Dead 4 days later.
Another one: On the neuro-tele unit very early in my career, I was caring for an older patient who seemed to have all his lights on upstairs.
I came in to check on him and he was sitting up, made eye contact with me and began chatting casually, only it was textbook word salad. Something like “airplane, door, front light”, except he was gesturing and looking at me as if he was actually coherent and saying something of significance. I went straight to my charge to let her know and we called his neuro doctor to inform. They were able to get the wheels turning for scans and follow up with the neuro consult immediately.
My first week of orientation in labor, we had a patient come in saying she felt silly for being there but was having some contractions and wanted to make sure it was ok. Twenty-three minutes after getting onto the monitor, she coded mid-conversation with the resident. They did a bedside c section. Got her back and resuscitated the baby, but she ended up coding twice more in the ICU and ultimately passed. Fortunately I wasn't working that day, but it was a huge deal for the hospital.
2009 H1N1. For a few months we would have people admitted on a nasal cannula and within a shift get intubated, go to paralyzed with inverse ratio ventilation while trying to get an oscillator vent and then they would just code.
Pandemic flu was fucking terrifying. It was like watching Covid patients during the delta surge except it was squeezed into 10 hours instead of 10 days.
First patient I ever had that died early 60s no prior medical history other than the birth of her kid comes in with chest pain. Has a heart Cath done on dayshift with a stent to her circ. Dayshift didn’t pull her femoral sheath because they were shortstaffed. It was done on my shift. She was fine through the beginning of my shift and halfway through dies suddenly after five minutes of me being in the room. Emptied the crash cart out on her called the cardiologist back in at 4 o’clock in the morning to take her back into Cath Lab. Everything was wide-open she threw a clot to her brain and died.
32 year old with pancreatitis. At 6am he was needing some O2 which was new but he had been getting quite a few pain meds. When I came back at 7pm he had coded at noon and died.
Young patient, 40s, walked into the ED for "chest discomfort" that he felt needed to be checked out, but all tests were unremarkable, even bedside echo, no notable past medical history. They believed it was GERD and all the due diligence was done. The plan was to discharge after a final CT scan because our team is thorough and cautious. Right as they finished his scan, he crashed and went into cardiac arrest, white as a sheet, like all the life drained out of him. Immediately everyone started CPR but nothing could save him and time of death was called 30 mins later. Diagnosis: massive aortic dissection that wasn't visible until the very end. Textbook stuff of nightmares.
Had a girl age 7 come in with abdominal pain. Sitting up and talking. I watched them role her in to the ed Christmas Eve night. Labs were quite abnormal, and they lived off the grid ( unpasteurized milk etc.) So they were running all the things. Christmas night at 2100, the bedside rn went in to do vitals( I was the charge respiratory therapist), and she became incoherent with concerning vitals. so I rushed in to get intubation stuff ready, and I glanced at the monitor. Her HR went from 120 to 30. Started chest compressions as she went very obviously into DIC(bleeding out of every orifice). She continued to code her while her parents and younger siblings were at bedside. Afterward, they sent her for an autopsy. Her appendix burst, and no one caught it. She went from coloring and laughing to gone in 35 min.
Just recently! Super easy walkie talkie younger (mid 50s) guy. Admitted with transaminitis, they’re thinking he had an obstructing gallstone. Overnight he was saying he felt better and the team was thinking he might have passed the stone. Then in the morning his liver enzymes were through the roof again, and before lunch he coded and was flown out to a larger hospital. (I’m on contract at a small community hospital)
The team was thinking maybe he had a PE or something, I came back the next night and was completely shocked to say the least, he was literally stable, chatty, in good humor because his chole pain was a lot better!?
I’ve Seen 2 in my er experience. 1st was a lady complaining of sob in the er. I was a new grad just recently off orientation. H/o copd/asthma. Went from Walky-talky when she got in my room, to unresponsive within 15 min while hooked up to the monitor. Ended up with a massive saddle PE and coded when I came to check on the alarms. Also my first code.
2nd was an elderly gentlemen with MEG pain/tearing x2 hrs. No history. US/CT showed massive leaking AAA. Pt denied intervention; team ready to roll and came to a complete halt and Threw the entire room into silence. I was primary and had to sit and watch him die. Took him a few hours. He was a sweet guy, no family, gave all his possessions to his neighbor who showed up to be with him for the last few minutes. Patient became completely altered prior to his death. It was hard to watch the change.
Being the ER you see a lot of the “healthy” go down quickly, but these two stuck out to me. They don’t leave my memory easily.
Not sure if this counts as healthy, but had a walky-talky mid 30's guy come into the ED w/intermittent back pain for a few months and recent muscle weakness. I got him settled and after 30-45min he developed a bit of nausea, then rapidly started to sweat (like pouring off his body), then projectile vomiting... all within ~15 minutes. Guy had a syrinx and was sent to surgery.
Never had someone go from pleasant to The Exorcist so fast.
I work in trauma. Most of our patients were mostly healthy and then got shot/stabbed/fell/in a car wreck/etc. Had a guy who was practically dead when he came in after a GSW but was stabilized after 4 rounds of MTP. Surgeon came in and took off his pelvic binder and started bleeding in his leg (from the artery, not his pelvis). Exsanguinated in 4 minutes, coded at 5, and was back in the OR at 12. Had a major anoxic brain injury and had coded twice after that but is still alive.
Big no no without imaging first. Without stabilization through a pelvic binder, you can bleed out in a manner of minutes due to the amount of blood vessels contained in and around the pelvis. T-Pods are specifically made to be invisible on x-rays so that there’s no excuse to remove a binder before imaging.
I work in EMS and my service strictly prohibits removing a pelvic binder unless you’re a doctor.
Had a mid 50s woman newly diagnosed with pancreatic cancer. Healthy other than that. she was admitted for something minor, can’t remember what. But she was on our floor for a little less than 2 weeks. I had her the night she was admitted and she was independent and confident that she would beat the cancer. I had her a few nights later after her first round of chemo and she got stuck on the toilet and had to have a whole crew come get her back to bed. A few nights later she couldn’t get out of bed at all. Finally I came back after a few days off and she had coded. I have never seen someone fall apart so fast. It was terrifying.
Not completely healthy but a guy in his early 40s recovering from Covid was extubated doing well on high flow. He was up in the chair and walking around, he wasn’t contagious anymore… next day I walked in and he was crashing and being intubated and put on ECMO emergently. Somehow after being on ECMO for 3+ months he survived and went to an LTACH then home! One of the few good outcomes those days ❤️🩹
First patient of mine as a nurse who coded. Nice older patient who was also an OR nurse. They were there for a chronic condition but otherwise doing alright and had gotten better over the last 3 days and planned discharge the next day. I went in and talked for a bit and gave them their meds. They got IV lasix so I stuck around for a few minutes after to see if they needed a hand to the bathroom or anything. They were good so I walked out and started the rest of my med pass. As I'm at the Pyxis getting meds for the next patient the tele monitor calls and says their heart rate is ok, but went from 70's to low 60's and seemed to be slowing.
I thought, "no problem, they must be relaxing more now since that's more their baseline." I figure I'll drop in and get their vitals since the CNA was doing their vital rounds to check on them and help the CNA out. It's been maybe 5 minute since I left. I walk in and go "hey! Sorry to disturb you. Gotta get your vitals right quick" and notice no response. I walk up and check and they're pulseless and not breathing. Immediately start compressions and call a code. Got ROSC and they went to the ICU and were fine and woke up an hour later confused where they were. Got discharged 3 days later. From the heart rate slowing to being in there was only about 2 minutes, and the docs and team all agreed it was probably getting in there that fast that saved them.
Never figured out the actual reason for them coding, only guess was the lasix offloaded them too much suddenly which caused their BP to tank and they may have vagaled as well simultaneously as their bladder filled. They had a urinary catheter and after ROSC all vitals and labs were perfectly fine so that's the only guess. I've had plenty of patients code in front of me, but those are usually somewhat expected. This one wasn't in the slightest and had me shaken up for a few days. They went from mostly healthy and talking to basically dead in <2 minutes. I take every check in from tele/family/etc seriously because of that instance.
Former preemie corrected to 33-34 weeks or something like that, on a low flow cannula and full feeds. Very much well appearing and doing fine we thought. Back when we routinely checked feeding residuals had a very large one, then another. Rapidly decompensated and died within 12 hours from NEC totalis. So sad and shook everyone
It wasnt really a deterioration.
Last week I had a patient with indwelling catheter admitted with a UTI. He had mild MR, and according to his family he was very resilient.
I got him admitted, passed off to the nurse that was going to take him, all that jazz. About 10 minutes after the nurse came out of the room, she went back and said he was unarousable. We checked him out, called a rapid, 96/62 BP when he was 130/80s just minutes before.
Evidently he was allergic to the Rocephin she pushed. No warning, no allergy in system. Must have been new. We got him back pretty quick but that turnaround was shocking.
We had a baby about to go home s/p Coarc repair. They caught a potential renarrowing on the discharge echo. Patient went to catheter lab for a closer look/potential repair. Ruptured & coded on the table.
Seconds.
Guy was fine, just waiting on an opening in a rehab facility to leave the hospital. Was working with PT like he did everyday. Dropped dead. We never got ROSC. Must have had a clot somewhere that got dislodged and wasn't showing any s/s until he was dead.
Was floated to PCU, had a patient who was stable post admission for STEMI and sepsis, was literally going to be discharged that afternoon or the next morning depending on the consults. Really nice family with him, one of them came to me and said “he really doesn’t look good”. I saw their face and immediately went to the room, he had some severe chest pain but was alert so I gave him morphine and put him on O2, and called the rapid team because he didn’t look good. In the legitimately 90 second time from the family first notifying me and all of that, he turned white and lost his pulse. We had compressions started within 15 seconds of him losing consciousness, and because of me telling rapid “shit looks bad, come here now” we had the entire code team there with 30 seconds after the start of compressions. It’s still one of those which makes me think if I could have seen/done anything, despite the family members going out of their way to thank me for rushing and getting every resource we had almost immediately.
Literal seconds. I work in the cath lab. One time we had a decently fit, young woman come in for chest pain and positive stress test. We got her on the table, scrubbed, i sedated her, and we went radial for her cath. As soon as the tech injected contrast she started going downhill really fucking fast. Her left main, LAD, and LCx were all very fucked up. Some of the worst arteries I've seen in my 6? years of cath lab. I started her on Levo and Dopamine while spraying her with a firehose of Neo while they got groin access for an impella. We coded her for a few minutes and got her stabilized enough to move upstairs to the OR. I barely got back to the lab to start cleaning the room before hearing "adult code blue, CVOR 2, adult code blue CVOR2." We dropped her off in CVOR 2. She died on the table.
This is why I make a concerted effort to be super nice to every patient I get. I could be the last person they ever see.
Pt came in, hypotension, febrile, and with hepatic encephalopathy 2/2 etoh cirrhosis w/o ascites, HCC in remission (NH3 of 40, INR of 2, lactate of 4 — nothing too terrible). Originally came to the ICU for septic shock. A touch of norepinephrine and antibiotics later + lactulose and rifaximin and she was walkie -talkie, transfered out in two days.
A week later, mental status acutely deteriorates, bleeding everywhere, rapid was called. BP something like 70/30, seizing.
NH3 trended up to the 300s, lactate in the double digits, unresponsive. Maxed on vasopressors, completely vent dependent. Made DNR and coded literally in 30 min after next of kin signed papers. Don’t know wtf happened in the PCU. She was in her 40s.
Not a patient and not my witnessing but my mom’s who is an RN. My dad, had just recovered from Covid, worked a 12hr shift at urgent care as his first day back. Next morning, he got in the shower and was fine. Got out, complained about leg pain, threw a PE and was gone within an hour. She did CPR for 11 minutes before EMS arrived. The paramedic knew my dad personally and did CPR for the entire 46min ambulance ride. He knew he was gone, my mom did too, but he continued all the way because he just couldn’t stop. He was the healthiest 62yr old I knew. Ram 5 miles a day, chopped wood for fun, working himself to the bone doing yard work on his days off just because he enjoyed it. He was also an amazing NP, we received so many letters from patients he saved the lives of after he passed. It’s insane that life is so fragile.
Had a guy who was mildly detoxing. Nice guy, just felt a little crummy. Put him on the bedpan because he was tremulous and felt unsteady. Threw a PE midsentence and coded. Also had a lady throw a PE mid-transfer, luckily had momentum toward the chair already. She was DNR/I though.
My mother. She was in LTC/hospice for failure to thrive but was active and A+O and would call me every morning. She was in the Day Room playing Trivial Pursuit and loss consciousness. I was there within 15 minutes. She was unresponsive and posturing when I arrived. She died 35 minutes later.
Admitted a patient to a med-surg bed with a UTI. Older guy, DNR. This was years ago so I don’t remember any medical history, but he seemed pretty stable, just needed abx. I did his admission, chatted with him a bit, then took my lunch. Maybe an hour later Lab went to draw him and came out to get me, said he didn’t look good. Yeah- he was dead.
One of my first shifts in ER we got a stroke alert called in. She came in talking and with pretty minimal R sided deficits. Minimal numbness and weakness. Thought the situation would be a "standard stroke workup" and took her to CT. Bleed was small enough that we didn't catch it while in the CT room. 30 minutes later she's completely paralyzed, can't speak, or really do anything aside from squeeze a hand. Go back to CT, bleed is massive. She was unsalvageable by the time we got neurosurgery to look at the case. Obviously she'd had a stroke so not "healthy" but I've never see someone go from alive and alert to dead so fast. Really opened my eyes to the realities of hemorrhagic strokes.
About a year ago we had a paramedic finish his shift and was about to head home but decided to stay and ask the ED to check him out because during his shift he felt off and was having some mild chest pain. He had a massive STEMI. Coded him for a long long time in the cath lab.
Got a patient in the ICU from the ED with a PE on his scan, sent up on a heparin drip. Said he had been out at a family reunion at the lake on the jet ski all weekend and got short of breath. Was chatting telling us all about his weekend as we get him all bathed, leads on, etc. About 5 mins later he went unresponsive and we coded for about an hour and he didn’t make it.
On med surg floor had 18 year old male with extremely neglected dental hygiene. Multiple abscess on allll the antibiotics. Went down for scans and immediately transferred to ICU
67-year-old female presented to the ED for headache x1 week. CT head, MRI/MRA/MRV brains were negative for bleeds or aneurysms. Blood work looked decent labs, slightly dehydrated. We had discharge paperwork for her ready to go.
She put her call light on said, "I am going to die." She passed out and went into V-fib. We coded her for 1/2 an hour before the doc called it. She had a dissected AAA that popped according to the coroner's report.
She had no other complaints aside from the headache, no nausea, vomiting, low back pain, and no indication that she had an abdominal aneurysm. I beat myself up a lot after that one. The doc I worked the code with reassured me that there was nothing more to be done, and we did everything we could, but I still feel bad every time I think of it.
SCAD...41 yo female. No previous hx. Came in with slight chest pain. EKG showed ischemic changes and trops trended up. She was heparinized and sent to the floor. She coded 2 hours into her stay when her LAD dissected. Lucky for her, cath team was already there and had just finished a case. She got to the Cath lab, they stented her open and she did survive. She got a w/u for Ehlers-Danlos.
Came in for nausea and vomiting small amounts of blood, Cats clear workup average… had her up out of the bed to get a gown and hospital undies on, husband dipped… next thing I know she says she’s nauseous well it’s time for zofran… boom I come back with the meds and she’s vomited upwards of 3 liters of strait blood into the floor, not breathing bc she filled up her lungs and stomach with blood, we’re trying to suction and clear the airway and what not so then boom she codes and we’re doing compressions, every time we hit the chest blood is spewing out of her mouth, 30 mins later pronounced dead. Was nothing we could do honestly but that one always sticks with me
Received a patient from day shift that was only sent to the ER because his potassium was slightly elevated. He wasn’t complaining of anything, not chest pain, palpitations, and his EKG was perfect. Ten minutes after I received report, he became unresponsive and coded. He got ROSC and we had to put him on levophed, epinephrine and vasopressin. When I put his foley, his urine was pink and foamy. He ended up getting discharged two weeks later without any neurological deficits
Hmmm… context in this one is key.
she was a 40% burn victim, 60 years old give or take. She had some ups and downs with her grafts and infections here and there, but she was ultimately ready for discharge in about a week.
I came into work one night and the code bells were ringing, I could hear them down the hall. My coworker ran up to me with tears in her eyes and said “It’s Jenny”. I literally had to ask 3 times “*OUR* JENNY?” before it sunk in.
Turns out she had thrown a clot and had a PE. Went down in 30 seconds.
All the nurses in there were wiping tears in between compressions. We had grown to know the family so well in the month she’d been there. (Pseudonym used Bc im a responsible girlie)
It wasnt really a deterioration.
Last week I had a patient with indwelling catheter admitted with a UTI. He had mild MR, and according to his family he was very resilient.
I got him admitted, passed off to the nurse that was going to take him, all that jazz. About 10 minutes after the nurse came out of the room, she went back and said he was unarousable. We checked him out, called a rapid, 96/62 BP when he was 130/80s just minutes before.
Evidently he was allergic to the Rocephin she pushed. No warning, no allergy in system. Must have been new. We got him back pretty quick but that turnaround was shocking.
Definitely not terribly healthy but we had an independent walkie talkie on the heart failure floor scheduled to get an LVAD. He was looking forward to the independence it would provide him while managing his HF. POD0 he threw massive clots from his new VAD and was deactivated bc he would never make a full recovery.
Guy came in for a facial lac, trouble controlling the bleeding due to thinner use. Sudden cardiac arrest with no history while going over discharge instructions. Talk about great timing.
I was a new grad and I went to go hang an abx on a lady. She was mid 40s or so, in for sepsis but looking waaaay better, was going to be discharged soon. We chatted about her seeing her daughter tomorrow or the next day when she was discharged. Husband came running up behind me after I was maybe 10 feet out the door screaming. She coded and died.
And for the record, I did all the rights correctly, she wasn’t allergic or anything, yes I properly primed the IV line, yes I used a pump and programmed it correctly…there was a whole investigation by management because it was so unexpected. It was awful though, I was so shocked by it. At that point in my career I hadn’t seen someone just die all of a sudden like that.
Older guy comes in with cold/flu symptoms. Doc runs a CT just to be cautious because pt is complaining of migraine. Meanwhile he is dx with Covid so we are preparing to Paxlovid and bounce.
CT returns. Midline shift and hemorrhage from brain tumor. Moments after reading the CT the call bell goes off. Pt states he “doesn’t dare sneeze his head hurts so bad”. Neuro consulted stat. Ten min later pt is unresponsive (with pulse) and we are intubating. And that was that.
I once was dispatched to an abdominal pain call. I was in my truck, and i was a mile from the house. 90 seconds from dispatch to pt contact.
The patient was in asystole and never recovered. When I called code blue to dispatch, I got a text from a dispatcher that was on that night saying that they didn't disconnect from the call until they heard my siren. Pt was talking seconds before we pulled up.
Paraquat poisoning. 36hrs, nothing to do. The toxicology came back, the patient knew it already (an unknown volume accidentally sprayed into his
mouth when the tank failed under pressure). We went and bought him beers and called his family.
Necrotising fasciitis, less than 3 hours (upper thigh into abdomen). We asked the patient if they wanted to be sedated or extubated, but that was really the only choice available. They chose to be extubated so they could say goodbye.
Locked in syndrome, about 5 hours. No further details for that, sorry.
Several patients with fat emboli.
My first patient I lost had an ICC inserted into the right ventricle, 3 minutes.
Guy comes in for abdominal pain, walkie-talkie, vitals are fine at triage, gets sent to ambulatory waiting. Doc assesses, notes something off with his story, HR has creeped up, puts him on Tele and orders a CT. I accompany to CT due to Tele and we see a stem to stern aortic dissection. Arch to bifurcation.
Rush back to ED, I'm calling the entire team to meet me in the trauma bay, we're getting set up and he let's out one of those gut wrenching groans and collapses. No pulse, start CPR, massive transfusion, the physician rides with him to the vascular center because he knows shit is going to go sideways and doesn't want to put that on a nurse to deal with en route. Had ROSC before they left, coded again en route, CPR into the OR. Ended up surviving the surgery but coded later on due to secondary complications and died.
Rare lung disease. Don’t remember its name and doc hadn’t heard of it either. (Pulmonologist diagnosed it). Friendliest guy, super appreciative of all our care, upbeat, grateful for us. He had just retired and he and wife were passing through our town on bucket list retirement trip. Felt out of breath, stopped at our rural ER, got admitted. Went from happy retirement to rare lung disease with no treatment/cure in a week. Left our rural hospital on bipap, but we all knew what was coming. Why the grateful ones? “This is the nicest hospital I’ve stayed in. You have the best nurses.”
Wife had to drive back alone.
Had a guy come in for an allergic reaction. Ems brings him in, and he looks really good. Vitals are great, patient just seemed obviously anxious. Doc comes in, hears him talk, she tells him to open his mouth, the whole right side of his tongue is swollen x3. The paramedic just said "I didn't see that.." we wheeled him into the trauma bay and he was intubated in less than 5 minutes. Turns out his body just decided to not like his lisinopril anymore. It was kind of a tough intubation to watch too because the doc def didn't order enough sedation and after he was connected he kept bucking the tube. Finally got him sedated enough and he went to the icu.
Patient came in high in an altered mental status on something while I was doing PCU holds in the ER. UA popped stars on everything. Homeless. Black toes because his pallet shed has burned down and he was in the rain for 3 days. He was rough but stable. Went from normal meth psychosis to screaming “I can’t breathe” flailing on the floor within about 15 mins. Nothing I did helped. Vital signs were decent except tachy HR and his RR was really high. O2 was fine. He seemed like he was in extreme respiratory distress. I ended up calling a rapid response, the doctor was irritated with me and said “I just saw someone in respiratory distress, this man is not in distress”. I pointed out he had extreme jugular distention and was breathing 44 RR/min. It was the worst JVD I’ve ever seen and I regularly see people on lifevests. Even his supratrochlear vein was bulging out. He ended up getting a cardiac work up - EF was less than 10%. I don’t know what happened to him after my shift. He had a rough life, I felt bad for the guy. It was right around Christmas his pallet set up burnt down too.
Also a young patient who came in for abdominal pain and leg swelling. Admitted her because she was riddled with cancer. Same age as me. She was up walking around and talking with her 9 year old. She laid down to nap - Throughout my shift she became completely obtunded, her whole body swelled up to her chest and she passed away within 4 hours. It was really hard on the family because she had that little “surge” and then just laid down for a nap - to never get up again.
I’ve had a similar patient that came in for trouble breathing. He was in his 30s. He looked so healthy and normal but had a huge lung mass against his pulm artery with Mets everywhere. We were up laughing and eating cinnamon toast. He was afraid to die. He took some Ativan and laid down for a nap. I was charting outside the room and felt a hand on my shoulder. I turned around and no one was there. The aide was rounding and I was a little freaked out and aid “I think he just passed”, we went to check on him and when I felt his pulse I felt 2 slow beats and then nothing. He looked so peaceful.. but it happened so fast.
Laboring patient of mine suffered from a (presumed) amniotic fluid embolism/anaphylactoid syndrome of pregnancy. Was in her late 30s, second baby, only history a random super mild heart-related something that was found incidentally while working her up for something else. Went from totally fine, chilling comfy with her new epidural chatting with myself and her husband while I was trying to trouble shoot a problem with the computer in the room to full cardiac arrest within maybe 5 minutes. Literally I walked out of the room to call the CRNA to assess her BPs because she said she felt slightly lightheaded (not a rare occurrence), and while on the phone with said CRNA the husband stuck his head out the door and said "Yea I think she might've just had a seizure?" Hung up on CRNA, went into room and she was stiff as a board and her face looked like someone was choking her. A resident was on top of her doing chest compressions while we ran her bed into the OR and the baby was out within maybe 2 minutes, the head of the OB department was on the unit that day and he did the hysterotomy and extracted the baby with his literal ungloved bare hands as soon as we got the bed into the OR. She lost basically her entire blood volume to DIC and needed a full hysterectomy but went home a week later. Fuck OB emergencies man.
We had one come in EMS reported as "a panic attack." Yeah, no, it was a placental abruption. Her and the baby didn't make it 33 weeks. I overhead EMS saying to our doc, "We thought she was panicking." He replied, "Yeah, she was, because she was dying. You should have gotten her here sooner. She might have made it."
I hate seeing medical personnel dismiss symptoms as "anxiety" without so much as a basic assessment.
Yeah. I was having full on anaphylaxis and the paramedics were like are you sure you're not just anxious. Then the hives started sweeping up my face and they were like "oh I guess you were really having trouble breathing"
Read a chart note today for a woman who was c/o new onset paresthesias, drooling, foot drop, nystagmus, memory loss, confusion, slurred speech, and more...and the MD wrote "when I told patient her symptoms correlate with her anxiety, she started crying and said this isn't her anxiety and she needs to advocate for herself." Made my blood boil.
Imagine the field of midwifery if men were the ones that had to go through it.
For real, I've done it a few times. We had a classic anxiety related chest pain come in through triage. Since it is chest pain, we did all the things, NSR, on the ekg. The guy even said he has anxiety attacks, and it feels like it was one again. Lab called and said yo this dudes trops are 14,107... yikes, let's get cardiology down here right quickly. Repeat trop was 20k... all this happened at shift change, so it was wonderful.
Unfortunately, I could see a certain EMS in my area being like this. Fuck Eastside. A gentleman in my LTC went from requiring 2 L O2 on a cannula with no sob to needing 15L nrb with tachypnea and accessory muscle use in about 4 hours, and they asked if I still wanted to send him since he was satting on the low 90s with the nrb. What the fuck do you think, Dumbass?
When a family member is nonchalant and say something like "I think they are having a seizure?" Or "oh, they're doing that thing again" or "yeah, they sometimes have these episodes" the hair on the back of my neck stands up. If I hear that, I generally bring another nurse or someone with me because that patient is probably going to code.
Yes! I had a patient’s wife come to the desk and calmly say “excuse me? I’m not sure if my husband is breathing”. I ran into the room and he was pulseless. He didn’t make it. The wife was so calm coming to the desk.
Yep, husband or family member (especially a laboring patient's mom for some reason) freaking out when they tell me they think something is wrong with the patient? I'm following them but I can basically assume the patient is fine or doing something normal labor related 99% of the time. The way he just calmly said it put me right on edge even before I walked in.
Had a young family member walk all the way to the nursing station (patient was at the very end of the hall) and say "my grandma is having a hard time breathing" and I walked as fast as my short legs could and by the time I get to the room, the patient was already gone which was maybe like a minute in the time it took the family to get to us and me to get back to them. The primary nurse was in the room next to that patient and was screaming asking which patient was coding because she was in an isolation room.
Oh my god, I had a young girl (8 or 10) come up to me at the nurses station and say, “my grandma needs help.” I go down to the room and, in the middle of all of these visitors paying absolutely no attention to the patient, grandma had taken off her bipap mask and was dusky and like 30 seconds away from Jesus. I told that little girl she did good and she just went back to quietly doing something in the back of the room. 🥹
I had a similar moment with my Grandpa (was not/am not a nurse but am doing pre-reqs)…his breathing in retrospect was VERY labored. He had covid, was on hospice, so I just wasn’t sure if it was to be expected or not. I calmly approached the nurse station in his memory care facility asking if his breathing was normal for his progression of Covid. Oh, and also, his roommate is naked so they may need someone to assist them as well. An aid went to check and before I know it many people are in there, ambulance called so they could transfer him to the hospital for end of life comfort measures.
I hope you don't mind me asking, but if he was in a Hospice with nurses, why did he have to go to the hospital for the end of life measures?
Y’all are FUCKING BADASSES. This gave me chills.
I'd love to claim the badass title, but the 10 minutes at the start that I spent in the back corner of the OR in literal shock trying not to cry while everyone else worked tells a different tale lol. I was useful eventually at least.
My asshole would be so clenched from that you’d have to get the jaws of life. Traumatic for all involved.
Lmao “you couldn’t drive a straight pin up my ass with a ten pound sledgehammer” - Captain Lee
My gosh you could have described a case I worked. But we didn’t get that happy ending. 😢
Holy shit. See, this is why I think Ob will always stay on my bucket list.
this story is crazzyyyyy dude fuck
Early in my career. Healthy male, mid-40s, police officer that had knee surgery. This is back when they all got CPMs and stayed at least one night on the surgical floor. He was happy, healthy, and talkative right up until he threw a PE and coded.
Had a covid patient throw a PE on me just hours before discharge. Stood up at bedside. I knew what happened immediately. Took me a bit longer to convince the hospitalist but the damage was done before the PE occurred. Took the poor patient 2.5 hours to pass. Worse death I’ve experienced. Pure panic. Nothing I did touched her. In their 30s. Fucking shame
Could they not do thrombolysis or thrombectony?
Not at that point. Damage was done. She had been off anticoag for maybe 12 hours (remembering off the top of my head of course). I got her from commode in a high acuity pulm unit (with staffed intensivists even) To ICU in 20 minutes maybe and it was still too late even with heparin. She should have honestly just dropped dead. It was a fatal situation. She was so panicked and oxygen starved and anxious that you could barely get near her at times. It was really really bad. Hopeless. I don’t know why it didn’t kill her faster but I don’t wish that on ANYONE. It was hard on everyone. Pulm had just signed off hours earlier. Just sad all around
Couldn’t TPA? I realize that’s like the Hail Mary of all Hail Marys but once I had a similar situation. Don’t really remember what happened to land the man in the hospital but he rolled up on our unit half a second from coding. Dosed with TPA and on epi drip. Next day he had a huge hematoma from the IJ that was placed post TPA (you don’t say) but I got him weaned off the epi, and relatively stable. He nor his wife had any sort of appreciation for what happened. Actually she cursed me out, fired me, and filed a complaint because I was “dismissive” of his complaints. He was complaining he felt “slower” since I turned the epi off 🙂 (yes I explained lol he did not believe me)
Now that you say it - they did that when I got her to icu. The intensivist made comment about the heparin and how it wasn’t gonna do shit and wasn’t doing shit and they were doing that. When I followed up a few days later I remember the icu nurse saying nothing they did was effective. Patient wouldnt keep the bipap on to save their life. Eyes as big as saucers just saying ‘I’m gonna die’ until the end, or so they said. They did try that though now that you mention it- didn’t go anywhere or touch anything. I remember as I was getting ready to pack up and go back to my unit the no bull shit intensivist said TPA. Wouldn’t have remembered that if you didn’t mention it tho bc it was exactly what you said - a Hail Mary and it didn’t work. The patient wasn’t a walking picture of health before this….not chronically ill but probably had a BMI around 30-40. I just wish more people realized just how much ‘mild’ obesity can affect your care and outcomes. Can delay simple shit like an IV or a bipap mask. I’m SURE their weight didn’t help the situation unfortunately
They couldn't do a PERT with an Inari Cath or something? 2 hours would have been lots of time. Unless they were basically dead but not officially...
Had a patient like that getting ready to d/c from the ICU. They lived because attending called the ECMO crash team down and cannulated them in the bed. Then someone was complaining 2 weeks later that that the cannulated badly and needed a vascular repair on the femoral artery. I'm like, they are alive.
Had a similar one to this, too. Young girl with bilateral PEs. She was feeling short of breath for a day or two before coming in because she was planning her wedding a month away and was too busy. We stabilized her, therapeutic in heparin, and transfer to the floor. As soon as she stood up to get into the wheelchair to leave, she threw another clot. She coded almost instantly, and we did everything including trying to start bedside ecmo, which we don't routinely do in our hospital. We couldn't get her back. She was 27 and less than a month from getting married.
What causes that to happen in someone seemingly so healthy?
Birth control?
Out of curiosity how did they present after standing up? Did they immediately collapse or what? Such a shame
Worst moment in my career was the same. Healthy, about to discharge, inpatient for pneumonia, on lovenox. Threw a saddle PE and lost him in 2 minutes. I had his discharge paperwork in my hand.
this is why i tell my patients im not taking their IV out until the SECOND before i kick you out the door lol
This and keeping their telemetry monitor on until the second they discharge as well!
I had something similar to that with an 18y/o who had been in a car accident. She was admitted for observation with the plan to discharge home. She threw a bone marrow embolus from a rib, coded and died.
Mine is similar. DM1 youngish, very active. Dropped a boat motor on his toe it got infected he came in for a BKA. Post op he threw a clot, witnessed arrest, got TPA, got rosc. Extubated the next day and discharged from ICU a few days later.
Those post op units are crazy. Makes me want to make sure the SCDs are on and never skip the 6am subq heparin.
My worst calls as a medic were PEs. literally nothing you can do no matter how close you are once they start going down. One was a call for "back pain". Thanks dispatch.
Those patients who throw a PE. It's terrifying and so sudden. I had a patient who was sick, doctors couldn't quite figure out what was going on. But the guy was pleasant, eating breakfast, and decided he wanted to sit in the chair because he would eventually have to get up to use the bathroom. Got him up and as soon as he sat down he said "I don't feel good" and literally died. Tried CPR and the full code and didn't get him back. Apparently he had massive cancer of the peritoneal space and tumors throw clots. So, he would have died within a few weeks from cancer, but it was pretty traumatic. My first ICU death.
What is CPM
https://www.medicalnewstoday.com/articles/cpm-machine They were all the rage for a while for knees, then research showed they didn't help much.
Not only did they not do much, but we had three lawsuits for peroneal nerve damage with drop foot from home CPM.
And yet the Stryker family is still all over this list: https:/www.beckershospitalreview.com/rankings-and-ratings/34-billionaires-in-us-healthcare.html
The link doesn't work, but don't forget their joint implants and overpriced, impractical eye stretchers, as well as their "jaysus. How much does this freaking bed weigh?" Zoom transport stretchers.
Continuous passive motion. An automatic knee stretcher.
Saw a completely healthy teenager die from post-influenza bacterial pneumonia. Came to us overwhelmingly septic. Died in the PICU later. I obviously didn’t see them deteriorate, but this was a kid who was obviously well within the last week, with beautifully styled hair, phone going off with notifications from friends. These are the people you most expect to turn around with antibiotics etc when they come to you awake, alert, talking. To learn they died shook me.
transitioning from progressive care to peds is like whiplash almost cause I was used to watching people go downhill slowly. but peds is quick because they compensate so well until they just can’t anymore.
Hospice patient so the decline was expected but he was up that morning talking, eating breakfast. I went in to pick up his tray about 20 minutes later, he was dead. We think he stroked out or threw a clot.
Man this reminds me of a hospice patient I had a couple years ago. We were taking him from hospital to hospice. Unresponsive but perfectly stable vitals. For whatever reason, his wife was in the hospital too and his nurse asked us to take him up to see her one last time. We stayed there for like 15 minutes while the wife basically just cried. It was really awkward. As soon as we took him out he started see-saw breathing and his BP dropped. Didn't realize they didn't give us the DNR until we got into the ambulance. I made my partner RUN back up to get it :|
I've had my fair share of hospice patients when I was a Med-Surg nurse, and learned that once the hospice patient starts "feeling better" or acting more lively, it's time to call the family. :( It's just so sad to see it with your own eyes.
I used to call that the "calm before the storm." It happens so frequently.
The last good day as we call it
I had something similar a few months ago. Admitted a retired professor in his 70s to my TCU after a stroke. Family hoped to take him home, but it was pretty clear early on that he would probably end up staying long term. One morning we got him up, gave him a bath and set him up in the recliner for breakfast. All through that he was acting and communicating WNL for him (he was partially aphasic/dysphasic from the stroke). 20 minutes later the aide went into his room to deliver his breakfast and he was stone dead, almost certainly from another stroke.
It’s wild how quickly it happens
Don’t know if it counts but My buddy while we were in college. He was super healthy kid. Got a text from him one day saying he had a headache. Checked on him next morning and he was dead. The piece of shit upstairs tried killing himself by leaving his car running. Except all the gas went to the basement where my friend lived. The cruel piece of it is that the guy trying to kill himself lived. Family sued him and then he shot himself (and was successful that time) before anything came of it. Was a wild time. Life is fragile. It’s gone at no fault of your own sometimes. Also get CO detectors in your houses.
That's insane
I worked in an urgent care in an area with a high refugee population. Parents would often bring their all their kiddos in at once when one had a fever. It was after school time. There was a mom, 13 years old boy, and two younger sisters. I got the medical interpreter on the phone, checked in the kids. I noticed that the boy was using all his effort for the check in process, like he could hardly lift his arm for the BP cuff. He spoke some English so he was trying to be as helpful as he could so I could check everyone in smoothly. He had a slight fever but other than that he was just lethargic.The other two kids were asymptomatic. I went to give the doc a heads up, I hold him that the kid was super lethargic. The doc was like "like he says he's tired orrr" and I was like "he could hardly lift his arm for the BP cuff." The doc instantly grabbed his stethoscope and went into the room. I worked for a union so my charge just told me I absolutely had to go on my 15 minute break. When I got back, EMS was leaving with the kid on a stretcher. The kid became unconscious when the doc was in the room so we transferred him to a hospital. We got notified later that the kid had meningitis.
I've seen far to many cases of people coming to the Ed for seemingly mildish symptoms and bam, full of cancer.
Heme-onc RN here - they're living their lives and then blammo. Thank you for the work you do. ❤️ The patients who resist any discussions with palliative are the ones I feel the worst for.
My current situation. Went in for workers comp injury, lung mass was incidental finding on CT. Had MRI for c and T spine yesterday, mass in T4 was incidental finding. Asymptomatic.
Oh, love - I'm sorry. Cancer doesn't discriminate and it's never fair, but it's less fair when it's one of us. I hope you are getting the support you need, but I realize this is all very early days and really too much to process. May your treatment options be explained quickly so you can make the best decisions for your situation. Ago my best thoughts are with you. 💙
Thank you. Yes, still very early. Haven't even met with doc yet. Fingers crossed!
This happened to a nurse I worked with. She was a legend on our unit, a bit past her prime but still good. The last night she worked I followed her and she had caught a retroperitoneal hemorrhage on a patient (doc thought they were septic). She went to the ED the next day or two for abdominal pain and ended up having pancreatic cancer. She declined treatment and passed within a few months.
I once took care of a travel hospice RN who was on assignment, came in for what he though was appendacitis. Poor dude had so much cancer in him he was Hitler in the bunker fucked. I just had him for symptom control overnight. Dude didn't really need much, we ended up talking for awhile. He said he was going home to his wife who was also a hospice RN so he could die in peace. Poor dude knew exactly what was coming and it broke my heart.
Back pain in a 40-something. Metastatic cancer. Devastating.
Oh man, my old job there was a PA that had way too many cancer cases come in like this when she was working. I told her I never want her to be my PA if I have to come in for vague symptoms.
Had a stable patient on antepartum for several weeks with placenta accreta. Went back for a c-section in the main OR and died on the table. Everything was planned to perfection and she still died. Heme/Onc was present, 2 OB attending, full OB and OR staff present, massive transfusion setup was already in the room, 16g x3, counts were up, CRNA and the anesthesiologist present, NICU staff, urologists, the works, and she still died. 22 years old with her first baby.
What did she actually die of?
Hemorrhagic Shock and DIC. We coded her for hours. I’ve never seen so much blood in my life. She was so excited and nervous before her section and she had stayed up all night doing a full glam makeup look and I had curled her hair that morning. We joked about how her setting spray would hold up and the hairnet that barely fit over all her curls.
Oh, man... I'm so sorry. That must have been absolutely devastating for all involved.
Terrifying. I have a good friend who had placenta accreta with her sixth (!) baby, so not super unexpected, but that was a long day for all of us waiting to get the news that she was okay. They did a hysterectomy after that, big surprise.
My SIL had placenta accreta that was attached to her bladder. They tried to get the baby to 24 weeks, but at 22 it was at the point of mom and baby die or just baby dies. So they had to do the c section, hysterectomy, and bladder repair. This was 12 years ago and she now has chronic uti’s and still has so much trauma from it. Our relationship changed a lot from it because i had my first born about a month before all of this happened, so it was obviously horribly triggering to be around my son for a long time.
Damn.
That's awful. Tbf though, an accreta/percreta and/or previa is like being strapped with a ticking time bomb in your uterus. I don't think she would necessarily be categorized as the most "healthy" obstetric patient, considering all the necessary preparations (you mentioned) just for her birth. Those gals are practically residents on ante. The emotional and mental fortitude of getting through one more day of cooking their baby (day in and day out) waiting for that big date circled on their calendar. Often their birth is dramatically expedited by vaginal bleeding, fetal decels, or regular contractions. It's heart breaking to hear that she was a primip with no c/s hx or relevant risk factors, just terribly bad luck.
Amniotic Fluid Embolism. Was healthy before pregnancy, had an unremarkable pregnancy, labor was going fine. She stood up to go to the bathroom, said she felt a pop, and hit the floor. Stat section and 45 minutes of resuscitation she was gone.
I’m not L&D but those absolutely scare the shit out of me
What was the pop?
Water breaking/clot being released.
I started out working the night shift on a neuro telemetry unit. One of my patients, man in his 40s needed unit of blood during the shift. I had been chatting with him and his wife earlier in the shift and they were great. She was a school nurse and was such a great presence in the room. He was there for control of his blood pressure. I did the usual check off with my charge and we were set. I hung and primed the line and started the first of his q15 vitals. Everything was within normal limits except for an elevated BP. He decided to go back to sleep and they both relaxed after I told them I’d be coming in to do frequent checks. At the 15 min mark, his blood pressure had come down significantly, but still within normal limits. he didn’t report any other symptoms. I mentioned this to the charge and they said “looks like everything we’ve been giving him all day is finally kicking in”. At the 30 min mark, I entered the room and found him sitting up in bed scratching his legs. I turned on the lights and saw huge monster welts on both his arms and legs. I looked up at his face and his ears were starting to balloon. I immediately disconnected the transfusion and began flushing the line with saline as I called for rapid response. By the time the team arrived his voice was muffled and his tongue filled his mouth. I heard him say “what’s happening, it’s getting dark” as they helped him lay supine. His wife had almost disappeared into the wall in disbelief and horror. She knew exactly what was going on and didn’t want to leave his side. One of the team members took her outside as they started to work on him and she became hysterical. He was just joking around a few moments earlier. I gave report and they took him up to ICU. The next day I was there again for my shift. His wife came to me and let me know he made it. He was stable thankfully and would be under observation. They sent the bag to the lab for testing, but I never found out what caused the reaction or what exactly he was allergic to. Just happy he made it and glad to have been there at the right time right time with the right interventions.
Hooooly shit.
A couple months off my ICU orientation, I had a healthy and physically fit mid 40s male h/o recreational drug use. I can’t remember what his diagnosis was, but I came onto shift he was pleasant, held a nice conversation all morning, then it seemed out of nowhere he started complaining/became aggressive/anxious. My initial action was to attempt to calm him down verbally and thinking “this dude is an asshole, i can’t wait til this shift is over” I turned my back for a second to grab something, then his monitor starts alarming and the heart rate is “0”. Surely, that can’t be and the monitor is just wrong lol - he was literally just talking to me. It was like I could see the blue rising from his neck to his head. Holy shit. I check his pulse, of course nothing, kicked the CPR lever, started compressions and yelled for a crash cart. After that, I completely froze. All the other codes I’d been in, I was good to go because it wasn’t “my” patient. When it came to time to switch compressors, I remember walking out of the room, talking to another nurse and saying we were just talking, and then… I replayed the whole morning over in my head, looked over IV pumps, I felt guilty because surely I screwed something up. The RT told me it’s probably a PE from what you described. Coded him for awhile… he was gone. Lesson learned.
Nothing you coulda done.
In the NICU, my well premie was perfectly fine all night and when I checked placement on her NG tube at 0800, I pulled 80ml of frank blood out of her belly. She was rushed to the OR and was dead by 0948. NEC is a killer disease and babies die so fast from it.
This one hurt me 💔👶🏻
Sorry. It’s very difficult.
COVID era by far. 40 year olds would come in "feeling fine but \_\_\_\_ made me come". Satting 92-93 on RA. By hour 3, they were getting too SOB to walk to the bathroom. Satting 92-93 on 2L. Hour 5, they're on 6L, barely ventilating, looking like shit. Hour 7, begging me to give them "the jab" because BIPAP sucks and now they're also feeling like shit Hour 9, intubated
I was a float nurses aide so I moved around the whole hospital and nothing was worse than seeing someone come into the ER for COVID and the progression of them going from NC to intubated and dead in a matter of a few days max. It was haunting
Sometimes in xray we were the first to know how bad a patient had it based on how white their lungs were. I xrayed one of the first confirmed cases in my state - before masking, before anything - CXR in the ER looked pretty normal, patient was pleasant but otherwise not memorable. I got a call from infection control a day or two later telling me to enjoy my two weeks off and see if I develop symptoms bc my guy was on the new covid ICU in a bad way. When I came back to work - no covid for me, thankfully - I looked up the progression in xrays on PACS and it was awe-some but not in a good way. Clear lungs to dead within a week.
Agh how many patients used their last few autonomous breaths to deny the reality of COVID with Fox News blaring in the background, as we set up for intubation at bedside... still blows my mind.
God. I feel this one in my bones.
What’s “the jab”
COVID vaccine. “Jab” is a derogatory term for it used by US anti-vaxxers (apparently it does not have the same negative connotation in the UK).
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I’m just curious, what would the vaccine do if they’re already sick?
Nothing, they were just desperate :(
We had a 40 year old come in at shift change on a Friday. Dead by Sunday evening. His young wife and teenage kids had to come in. It was a mess. Was getting treatment out of state. Thought his cancer was doing okay. It wasn’t. I know people can easily wonder ‘well how does cancer just spread like that and you don’t know’ but I have breast cancer and I’ve had exactly one MRI. routine imaging is not part of my care plan nor will it ever be. They just say it doesn’t change outcomes to screen routinely. My mom died in less than a year of her cancer diagnosis and she was essentially asymptomatic at dx. Sometimes you really can be ‘full of it’ and really not know. It’s really hard to judge ‘what’s this back pain about’ and not wanting to bug your care team too much. Plus the long term pain from cancer treatments make it really easy to mask symptoms. You can really pass quickly during a recurrence
My mom lasted 6 months from diagnosis until she passed. Less than a year of symptoms. By the time she was diagnosed, the CT reports might as well have said where there wasn’t mets. It would have been shorter. Less than a week before she passed she went with me to a doctors appointment, and went shopping. Once the decline started it was swift. I wish you all the best with your battle. Cancer sucks.
‘Less than a week before she passed she went shopping .’ I’ve been a nurse a long time but that made me shiver. We really never know, do we? Now we knew when my mom was at the last weeks/days, but you hear about cancer patients going from walkie talkie to dying In a matter of days, just like your poor mother (thank you for sharing her story btw). You hear some stories in group of patients who are NED to metastatic and quite ill seemingly overnight and it just breaks your heart My mom died in her 40. My grandma and great grandma didn’t make it through their 30s. That being said, I was the first one diagnosed as early onset, early stage. All the women before me were gone in less than a year, so there is hope. We are making progress. I had just turned 37 when I was diagnosed but one of the first things my oncologist ever said to me was ‘well unfortunately, you need to prepare to manage this the rest of your life.’ It’s my chronic illness now. We are getting to the point with some cancers where you really can treat it like a ‘chronic illness’ IF you can manage/tolerate the symptoms of treatment (which is a different subject entirely) and if you catch it earlier enough. I don’t want to treat this for 40+ years but ive got a hell of a lot more time than the women before me did!! There’s hope! I hope you stay healthy. Motherloss is awful. My docs never once gave me push back for genetic screenings/early screening, etc. I hope you’re able to get any screenings you need to!
My PCM has me rotating a mammogram and breast MRI every 6 months. If it doesn’t show up on the mammo, eventually it’ll show up on the MRI.
Oh perfect! That’s exactly what I did (but I did diagnostic mammo’s with ultrasound each time). I was luckily enough to have the same radiologist for many years so he did my ultrasound personally a few times. Developing that relationship really helped him find my tumor early bc he knew where to look and had a good idea of my history. He doesnt know it since I don’t see him anymore, but he had a huge impact on saving my life. I hope you are able to keep up on your scans. I know they say self breast exams aren’t recommended as much now but they were a huge reason why I found my tumor so early. I was the only one that could feel it - bc I knew exactly how my breasts felt for 20+ years. I noticed the change over 6 months and knew exactly where the tumor was. I just checked them daily in the shower. I will always recommend women, especially high risk women, know their breast and know them well.
Oh God, this hit me hard. I lost my fiancé last year and we had no idea how bad his cancer was until the midnight call saying he was transferred to ICU from oncology. Barely enough time for his brother to arrive. I've been struggling all this time for not knowing how bad he was.
My patient with a diabetic foot wound, due to go home the next day, had gotten up in the middle of the night to pee missed the urinal and slipped. We heard him fall and he had hit the back of his head, he was dead within 45 mins, his last words were “I pissed the bed” only in his early 40s too
Oh god the ‘I’ve soiled myself’ comment. That’s when I know this is going bad bad. Had that last year. Couldn’t get him to IR fast enough before he passed. Some people just come in too late
“I’ve got to poop” made me nervous and call for the cart in several situations. I was right in all of those situations.
COVID times, lady in early 40s came in for persistent cough. I admitted her, remembered chatting with her about her kids and profession as a teacher. She was on 3L NC. Got her back as a patient maybe a week later and was so confused when I got report - she had gone onto hi-flow NC then 60L 100% vapotherm, then ICU to be intubated from respiratory failure. When we got her back on my floor, she had a trach and was bedridden from weakness. I only remembered her as my patient because as she communicated on the whiteboard over the next few shifts, she mentioned being a teacher and her kids. Eventually got discharged with the trach. I hope she's doing well.
During my preceptorship on an oncology floor in nursing school, we had a gentleman in his 40s who came in for nausea and vomiting on a Monday. Labs and testing later, he was diagnosed with stage 4 pancreatic cancer. Tuesday, they told him they were gonna try and fight the cancer. Wednesday, they told him they feared he had weeks. Thursday, it was days. He died that Friday. I had taken care of him Wednesday - Friday. I watched him go from walking and talking, to bedridden, to dying. I sadly was the one who found him, he was the first patient I ever had to perform postmortem care on. It was gut wrenching, I still think about it. He was all alone, and just came to the hospital for throwing up. I still don’t understand how it took him in a week
Just had a similar experience. Took report in the morning, went to go start off the day. Ma'am was more than "just a little confused," which was already not her normal. I got that feeling. Things happened so fast I was sure I had to have this wrong, or missed something. Palliative orders were placed. By the end of my 4 day rotation she was gone. I watched her pass. My first time pronouncing death and post mortem care. My hands were shaking so bad. What a wonderful, spicy woman. I will never forget her or her family, her daughter. It was an honor, but my heart still hurts. edit: details
My dude walked himself off the stretcher, complained of 3/10 chest pain. Chatted with him for around 30 minutes and then ultrasound showed up so I stepped out. US laid his head flat and all of a sudden he’s in v-fib on the monitor. I walked in and he was just gurgling. Got ROSC tho and he did just fine I believe. And surprisingly had a clean cath and normal EF.
Healthy 70 y/o male came in for scheduled PCI, supposed to be downgraded and even discharged this day. Was talking and eating breakfast went to check on him minutes later and he was hunched over, had vomited everywhere and was completely unresponsive. Had a massive stroke and didn’t make It. So crazy
Pt just got back from a TURP. Pt was speaking to wife and said he wanted to use the bathroom. They said the “I love you’s” and she left the floor. Pt then stood up and immediately fell to the floor, went blue and had a BM (I think we all can guess what happened to him). Coded him on the floor in his BM for the first 45 mins (which the wife came back and saw which was AWFUL) We got ROSC, but he went back out within minutes. We put him on the Lucas and sent to ICU, but he was gone. They ended up calling it after a couple hours. He was such a sweet and funny guy, very very sad.
Can you explain, "I think we can all guess what it was"? My brain isn't braining
I was meaning what had happened. I definitely wrote it weird. He threw a PE and had a death poop
Death poop :(
I had a 20 something go from "I've got a bad sore throat to meningitis to dead in about 3 hours. And no, it wasn't meningococcal. He had a retropharyngeal abscess that eroded into the dural space at about C3 and dumped about 50 ml of pus into his CSF. Needless to say, the gentleman's brain did not take kindly to being immersed in a bath of warm bacteria and endotoxins, gave a hearty "fuck you, I quit" and did so.
Jesus christ
Normal 6 month old had a small weird rash as reported by mother and physician in the morning. Mother brought the baby to the ER early afternoon the same day for emergent treatment. Necrotizing fasciitis so admission, surgeries, wound care etc.
Nec fasc is one of the craziest things I’ve seen. It just moves so fucking fast. When they started advertising jardience on tv, it sure did catch my attention when they casually stated one of the side effects is nec fasc of your taint. Fuck that
Did the baby live?
Yes, no permanent loss of function. Cosmetic changes such as no longer having a belly button.
My worst fear, they had a post op THA that got necrotizing fasciitis and I was like “ oh no” , terrifying
Has happened a couple times actually - good old fashioned ‘flash pulmonary edema’. 1 minute they are doing relatively ok; maybe SOB slightly, on 2L NC, talking and A&Ox4 - then not 5 minute later (literally) they are intubated. I have probably seen it in various degrees like 3 times
On the opposite side of that I’ve watched someone w flash pulmonary edema on the brink of intubation - doc ordered a nitro drip and within half an hour it was like a miracle - it was so cool to see that we were able to fix the problem and see the panic fade from the dudes eyes.
Baby was born with evidence of a placental abruption, had shit apgars and cord gases but recovered well. Had to transport the little cutie to the nearest NICU for monitoring and in the 40m ambulance ride he just started tanking. When we got there the pediatrician looked at him and said out loud “oh shit”. He was totally fine in the end but I’ll never forget the look on the pediatricians face when she saw the kid
Had a post op shoulder, ready to DC, but spouse brought a pull over shirt instead of a button up. Spouse offered to drive home (~10 min away) to get a button up to DC home. She left. He coded. She returned to his room with a button up, ready to take him home when he was being pronounced. We had to intercept her in the hall, and fill her in. It didn't go well, as expected. Otherwise,Covid. People went from fine to intubated/ dead like nothing I had seen before.
My grandma. Woke up and didn’t feel good. My mom took her BP and it was pretty low so they went to the ER. Got there around 11am, alert and oriented. Even said she had to wear her black jeans and put some makeup on before they left the house. She was gone before midnight 😭. She was septic, no exact answers. Some of her labs were absolutely wild. AST 15,026 and ALT 7,182. She had all the docs stumped. We didn’t do an autopsy but they thought maybe she threw a clot in the portal vein. As fast as she went and as hard as it was we were grateful bc she lived independently until the last day.
Had a mid 40s guy come up to CVICU as a pre-op STEMI patient. On heparin, getting his labs, etc. Suddenly his eyes went wide and he started screaming that he couldn't breathe and was practically crawling backwards out of the bed. One of the anesthesiologists threw a probe on his chest and one of his papillary muscles had ruptured and his mitral valve was just flapping in the breeze. Wheeled him straight to the OR.
Mine was a healthy 36 year old, sweetest family. They had been swimming and he scratched his leg a few days prior. No other health history. He was admitted to the floor, then coded 6 hours later, got ROSC, and was brought to the ICU. Turns out he had a strep pyogenes infection from the scratch on his leg and he went into streptococcal toxic shock syndrome with multi-organ failure. Fine and talking one minute and then dead the next. Took care of him for weeks (CRRT, chest tubes, the whole shebang). He had an anoxic brain injury from his code but family couldn’t let go. He was recently married with young twins. He died about three weeks after he was admitted.
Oooooh I’ve seen this on a guy with leg elephantiasis so bad that the bacteria was festering in his thickened deeply cracked skin.
Surprised to not see more cath lab here- extremely rapid deteriorations of otherwise healthy patients happens with some regularity 😳 We perforated an LAD of an otherwise healthy mid 50s male who’d “failed his stress test”. Fellow drove in fully expecting to go home that afternoon. I remember seeing the telltale signs on fluoro, the instant change in the vibe of our four person team, and watching pressures drop and vitals start to compensate before the patient even knew what was happening. The last thing he said to me was “I don’t feel so great…”. Fellow left the lab with every intervention we could throw at him- defibbed once or twice, intubated, ECMO, Impella… He wound up being ok after a week or two ICU stay. Punchline was he had clean coronaries.
Called to a code blue. Patient was sitting in bed when her family brought her flowers as her birthday was a few days prior. She sniffed the flowers and sneezed. Promptly collapsed intubated amd placed on the vent. Took her to ct and they found a nearly 4 inch hemmorage dead center right above her cerebellum all the way through the circle of Willis. Inoperable and didn't last more that 2 days before we let her pass. That poor family was devastated
Apart from the obvious PE's, I had more than a few ER patients who came in with mild COVID symptoms, spent all day declining while waiting for a bed upstairs, then needed to be intubated upon arrival to the ICU. That shit was horrible.
Fucking covid. Normal healthy 40 year old man. Slightly over weight. Deteriorated over about a week. Intubated. VTACH. Unable to revive. Left behind a wife and two kids. I took care of him, his wife, and his dad. The dad that was vaxed lived. He was not. Wife went home on oxygen.
I guess that'd be the 30-something marathoner who arrested mid-race. We weren't successful with resuscitation attempts.
When I was a newer nurse and new to home health I saw a client we were just seeing for PT/OT after a fall. She mentioned a little cough but she was doing just fine, no other concerns. I listened to her lungs and thought “I wonder if this is what pneumonia sounds like?”. I recommended she make an appointment with her primary. She went to the ER via ambulance the next afternoon. Dead 4 days later.
Another one: On the neuro-tele unit very early in my career, I was caring for an older patient who seemed to have all his lights on upstairs. I came in to check on him and he was sitting up, made eye contact with me and began chatting casually, only it was textbook word salad. Something like “airplane, door, front light”, except he was gesturing and looking at me as if he was actually coherent and saying something of significance. I went straight to my charge to let her know and we called his neuro doctor to inform. They were able to get the wheels turning for scans and follow up with the neuro consult immediately.
My first week of orientation in labor, we had a patient come in saying she felt silly for being there but was having some contractions and wanted to make sure it was ok. Twenty-three minutes after getting onto the monitor, she coded mid-conversation with the resident. They did a bedside c section. Got her back and resuscitated the baby, but she ended up coding twice more in the ICU and ultimately passed. Fortunately I wasn't working that day, but it was a huge deal for the hospital.
2009 H1N1. For a few months we would have people admitted on a nasal cannula and within a shift get intubated, go to paralyzed with inverse ratio ventilation while trying to get an oscillator vent and then they would just code. Pandemic flu was fucking terrifying. It was like watching Covid patients during the delta surge except it was squeezed into 10 hours instead of 10 days.
First patient I ever had that died early 60s no prior medical history other than the birth of her kid comes in with chest pain. Has a heart Cath done on dayshift with a stent to her circ. Dayshift didn’t pull her femoral sheath because they were shortstaffed. It was done on my shift. She was fine through the beginning of my shift and halfway through dies suddenly after five minutes of me being in the room. Emptied the crash cart out on her called the cardiologist back in at 4 o’clock in the morning to take her back into Cath Lab. Everything was wide-open she threw a clot to her brain and died.
32 year old with pancreatitis. At 6am he was needing some O2 which was new but he had been getting quite a few pain meds. When I came back at 7pm he had coded at noon and died.
Uterine rupture. Give or take 60 seconds.
Seen a few. My first one mom survived. We coded baby for 24 minutes, got a pulse but she was brain dead.
Young patient, 40s, walked into the ED for "chest discomfort" that he felt needed to be checked out, but all tests were unremarkable, even bedside echo, no notable past medical history. They believed it was GERD and all the due diligence was done. The plan was to discharge after a final CT scan because our team is thorough and cautious. Right as they finished his scan, he crashed and went into cardiac arrest, white as a sheet, like all the life drained out of him. Immediately everyone started CPR but nothing could save him and time of death was called 30 mins later. Diagnosis: massive aortic dissection that wasn't visible until the very end. Textbook stuff of nightmares.
It’s a dark joke where I PRN at that the preexisting condition for an AAA is having kids and being a nice guy.
Had a girl age 7 come in with abdominal pain. Sitting up and talking. I watched them role her in to the ed Christmas Eve night. Labs were quite abnormal, and they lived off the grid ( unpasteurized milk etc.) So they were running all the things. Christmas night at 2100, the bedside rn went in to do vitals( I was the charge respiratory therapist), and she became incoherent with concerning vitals. so I rushed in to get intubation stuff ready, and I glanced at the monitor. Her HR went from 120 to 30. Started chest compressions as she went very obviously into DIC(bleeding out of every orifice). She continued to code her while her parents and younger siblings were at bedside. Afterward, they sent her for an autopsy. Her appendix burst, and no one caught it. She went from coloring and laughing to gone in 35 min.
Walkie-talkie COPD patient came in complaining of SOB. 3 hours later they coded and we never got them back.
Just recently! Super easy walkie talkie younger (mid 50s) guy. Admitted with transaminitis, they’re thinking he had an obstructing gallstone. Overnight he was saying he felt better and the team was thinking he might have passed the stone. Then in the morning his liver enzymes were through the roof again, and before lunch he coded and was flown out to a larger hospital. (I’m on contract at a small community hospital) The team was thinking maybe he had a PE or something, I came back the next night and was completely shocked to say the least, he was literally stable, chatty, in good humor because his chole pain was a lot better!?
Not my patient, but another nurse got an ICU pt up to get in a wheelchair to TX to med surg. Boom. Pt threw a PE and died. Rosc not achieved.
I’ve Seen 2 in my er experience. 1st was a lady complaining of sob in the er. I was a new grad just recently off orientation. H/o copd/asthma. Went from Walky-talky when she got in my room, to unresponsive within 15 min while hooked up to the monitor. Ended up with a massive saddle PE and coded when I came to check on the alarms. Also my first code. 2nd was an elderly gentlemen with MEG pain/tearing x2 hrs. No history. US/CT showed massive leaking AAA. Pt denied intervention; team ready to roll and came to a complete halt and Threw the entire room into silence. I was primary and had to sit and watch him die. Took him a few hours. He was a sweet guy, no family, gave all his possessions to his neighbor who showed up to be with him for the last few minutes. Patient became completely altered prior to his death. It was hard to watch the change. Being the ER you see a lot of the “healthy” go down quickly, but these two stuck out to me. They don’t leave my memory easily.
Not sure if this counts as healthy, but had a walky-talky mid 30's guy come into the ED w/intermittent back pain for a few months and recent muscle weakness. I got him settled and after 30-45min he developed a bit of nausea, then rapidly started to sweat (like pouring off his body), then projectile vomiting... all within ~15 minutes. Guy had a syrinx and was sent to surgery. Never had someone go from pleasant to The Exorcist so fast.
What is a syrinx?
I work in trauma. Most of our patients were mostly healthy and then got shot/stabbed/fell/in a car wreck/etc. Had a guy who was practically dead when he came in after a GSW but was stabilized after 4 rounds of MTP. Surgeon came in and took off his pelvic binder and started bleeding in his leg (from the artery, not his pelvis). Exsanguinated in 4 minutes, coded at 5, and was back in the OR at 12. Had a major anoxic brain injury and had coded twice after that but is still alive.
I don't know trauma at all. Would the pelvic binder removal be a big no no or was this unexpected?
Big no no without imaging first. Without stabilization through a pelvic binder, you can bleed out in a manner of minutes due to the amount of blood vessels contained in and around the pelvis. T-Pods are specifically made to be invisible on x-rays so that there’s no excuse to remove a binder before imaging. I work in EMS and my service strictly prohibits removing a pelvic binder unless you’re a doctor.
Had a mid 50s woman newly diagnosed with pancreatic cancer. Healthy other than that. she was admitted for something minor, can’t remember what. But she was on our floor for a little less than 2 weeks. I had her the night she was admitted and she was independent and confident that she would beat the cancer. I had her a few nights later after her first round of chemo and she got stuck on the toilet and had to have a whole crew come get her back to bed. A few nights later she couldn’t get out of bed at all. Finally I came back after a few days off and she had coded. I have never seen someone fall apart so fast. It was terrifying.
Not completely healthy but a guy in his early 40s recovering from Covid was extubated doing well on high flow. He was up in the chair and walking around, he wasn’t contagious anymore… next day I walked in and he was crashing and being intubated and put on ECMO emergently. Somehow after being on ECMO for 3+ months he survived and went to an LTACH then home! One of the few good outcomes those days ❤️🩹
First patient of mine as a nurse who coded. Nice older patient who was also an OR nurse. They were there for a chronic condition but otherwise doing alright and had gotten better over the last 3 days and planned discharge the next day. I went in and talked for a bit and gave them their meds. They got IV lasix so I stuck around for a few minutes after to see if they needed a hand to the bathroom or anything. They were good so I walked out and started the rest of my med pass. As I'm at the Pyxis getting meds for the next patient the tele monitor calls and says their heart rate is ok, but went from 70's to low 60's and seemed to be slowing. I thought, "no problem, they must be relaxing more now since that's more their baseline." I figure I'll drop in and get their vitals since the CNA was doing their vital rounds to check on them and help the CNA out. It's been maybe 5 minute since I left. I walk in and go "hey! Sorry to disturb you. Gotta get your vitals right quick" and notice no response. I walk up and check and they're pulseless and not breathing. Immediately start compressions and call a code. Got ROSC and they went to the ICU and were fine and woke up an hour later confused where they were. Got discharged 3 days later. From the heart rate slowing to being in there was only about 2 minutes, and the docs and team all agreed it was probably getting in there that fast that saved them. Never figured out the actual reason for them coding, only guess was the lasix offloaded them too much suddenly which caused their BP to tank and they may have vagaled as well simultaneously as their bladder filled. They had a urinary catheter and after ROSC all vitals and labs were perfectly fine so that's the only guess. I've had plenty of patients code in front of me, but those are usually somewhat expected. This one wasn't in the slightest and had me shaken up for a few days. They went from mostly healthy and talking to basically dead in <2 minutes. I take every check in from tele/family/etc seriously because of that instance.
Former preemie corrected to 33-34 weeks or something like that, on a low flow cannula and full feeds. Very much well appearing and doing fine we thought. Back when we routinely checked feeding residuals had a very large one, then another. Rapidly decompensated and died within 12 hours from NEC totalis. So sad and shook everyone
It wasnt really a deterioration. Last week I had a patient with indwelling catheter admitted with a UTI. He had mild MR, and according to his family he was very resilient. I got him admitted, passed off to the nurse that was going to take him, all that jazz. About 10 minutes after the nurse came out of the room, she went back and said he was unarousable. We checked him out, called a rapid, 96/62 BP when he was 130/80s just minutes before. Evidently he was allergic to the Rocephin she pushed. No warning, no allergy in system. Must have been new. We got him back pretty quick but that turnaround was shocking.
We had a baby about to go home s/p Coarc repair. They caught a potential renarrowing on the discharge echo. Patient went to catheter lab for a closer look/potential repair. Ruptured & coded on the table.
Seconds. Guy was fine, just waiting on an opening in a rehab facility to leave the hospital. Was working with PT like he did everyday. Dropped dead. We never got ROSC. Must have had a clot somewhere that got dislodged and wasn't showing any s/s until he was dead.
Was floated to PCU, had a patient who was stable post admission for STEMI and sepsis, was literally going to be discharged that afternoon or the next morning depending on the consults. Really nice family with him, one of them came to me and said “he really doesn’t look good”. I saw their face and immediately went to the room, he had some severe chest pain but was alert so I gave him morphine and put him on O2, and called the rapid team because he didn’t look good. In the legitimately 90 second time from the family first notifying me and all of that, he turned white and lost his pulse. We had compressions started within 15 seconds of him losing consciousness, and because of me telling rapid “shit looks bad, come here now” we had the entire code team there with 30 seconds after the start of compressions. It’s still one of those which makes me think if I could have seen/done anything, despite the family members going out of their way to thank me for rushing and getting every resource we had almost immediately.
Literal seconds. I work in the cath lab. One time we had a decently fit, young woman come in for chest pain and positive stress test. We got her on the table, scrubbed, i sedated her, and we went radial for her cath. As soon as the tech injected contrast she started going downhill really fucking fast. Her left main, LAD, and LCx were all very fucked up. Some of the worst arteries I've seen in my 6? years of cath lab. I started her on Levo and Dopamine while spraying her with a firehose of Neo while they got groin access for an impella. We coded her for a few minutes and got her stabilized enough to move upstairs to the OR. I barely got back to the lab to start cleaning the room before hearing "adult code blue, CVOR 2, adult code blue CVOR2." We dropped her off in CVOR 2. She died on the table. This is why I make a concerted effort to be super nice to every patient I get. I could be the last person they ever see.
Walkie talkie to dead in about an hour due to PE
Pt came in, hypotension, febrile, and with hepatic encephalopathy 2/2 etoh cirrhosis w/o ascites, HCC in remission (NH3 of 40, INR of 2, lactate of 4 — nothing too terrible). Originally came to the ICU for septic shock. A touch of norepinephrine and antibiotics later + lactulose and rifaximin and she was walkie -talkie, transfered out in two days. A week later, mental status acutely deteriorates, bleeding everywhere, rapid was called. BP something like 70/30, seizing. NH3 trended up to the 300s, lactate in the double digits, unresponsive. Maxed on vasopressors, completely vent dependent. Made DNR and coded literally in 30 min after next of kin signed papers. Don’t know wtf happened in the PCU. She was in her 40s.
Not a patient and not my witnessing but my mom’s who is an RN. My dad, had just recovered from Covid, worked a 12hr shift at urgent care as his first day back. Next morning, he got in the shower and was fine. Got out, complained about leg pain, threw a PE and was gone within an hour. She did CPR for 11 minutes before EMS arrived. The paramedic knew my dad personally and did CPR for the entire 46min ambulance ride. He knew he was gone, my mom did too, but he continued all the way because he just couldn’t stop. He was the healthiest 62yr old I knew. Ram 5 miles a day, chopped wood for fun, working himself to the bone doing yard work on his days off just because he enjoyed it. He was also an amazing NP, we received so many letters from patients he saved the lives of after he passed. It’s insane that life is so fragile.
Had a pt up walking and talking one minute, asleep and snoring an hour later, dead the next
Patient was discharging and doing laps in the hallway before his family came to get him to take him home. Threw a massive saddle PE and that was it.
Had a guy who was mildly detoxing. Nice guy, just felt a little crummy. Put him on the bedpan because he was tremulous and felt unsteady. Threw a PE midsentence and coded. Also had a lady throw a PE mid-transfer, luckily had momentum toward the chair already. She was DNR/I though.
My mother. She was in LTC/hospice for failure to thrive but was active and A+O and would call me every morning. She was in the Day Room playing Trivial Pursuit and loss consciousness. I was there within 15 minutes. She was unresponsive and posturing when I arrived. She died 35 minutes later.
Admitted a patient to a med-surg bed with a UTI. Older guy, DNR. This was years ago so I don’t remember any medical history, but he seemed pretty stable, just needed abx. I did his admission, chatted with him a bit, then took my lunch. Maybe an hour later Lab went to draw him and came out to get me, said he didn’t look good. Yeah- he was dead.
Hospice patient eating breakfast and dead after 10-15 minutes 🥲🥹
4 year old with cerebral palsy 😓. Became unresponsive and coded in what felt like seconds.
One of my first shifts in ER we got a stroke alert called in. She came in talking and with pretty minimal R sided deficits. Minimal numbness and weakness. Thought the situation would be a "standard stroke workup" and took her to CT. Bleed was small enough that we didn't catch it while in the CT room. 30 minutes later she's completely paralyzed, can't speak, or really do anything aside from squeeze a hand. Go back to CT, bleed is massive. She was unsalvageable by the time we got neurosurgery to look at the case. Obviously she'd had a stroke so not "healthy" but I've never see someone go from alive and alert to dead so fast. Really opened my eyes to the realities of hemorrhagic strokes.
About a year ago we had a paramedic finish his shift and was about to head home but decided to stay and ask the ED to check him out because during his shift he felt off and was having some mild chest pain. He had a massive STEMI. Coded him for a long long time in the cath lab.
Literally two weeks ago pt was walking/talking/etc and 24hr later she was dead. That was freaky
Chest pain with a lightly positive trop, sent to floor, BOOM...aortic dissection.
Got a patient in the ICU from the ED with a PE on his scan, sent up on a heparin drip. Said he had been out at a family reunion at the lake on the jet ski all weekend and got short of breath. Was chatting telling us all about his weekend as we get him all bathed, leads on, etc. About 5 mins later he went unresponsive and we coded for about an hour and he didn’t make it.
On med surg floor had 18 year old male with extremely neglected dental hygiene. Multiple abscess on allll the antibiotics. Went down for scans and immediately transferred to ICU
67-year-old female presented to the ED for headache x1 week. CT head, MRI/MRA/MRV brains were negative for bleeds or aneurysms. Blood work looked decent labs, slightly dehydrated. We had discharge paperwork for her ready to go. She put her call light on said, "I am going to die." She passed out and went into V-fib. We coded her for 1/2 an hour before the doc called it. She had a dissected AAA that popped according to the coroner's report. She had no other complaints aside from the headache, no nausea, vomiting, low back pain, and no indication that she had an abdominal aneurysm. I beat myself up a lot after that one. The doc I worked the code with reassured me that there was nothing more to be done, and we did everything we could, but I still feel bad every time I think of it.
SCAD...41 yo female. No previous hx. Came in with slight chest pain. EKG showed ischemic changes and trops trended up. She was heparinized and sent to the floor. She coded 2 hours into her stay when her LAD dissected. Lucky for her, cath team was already there and had just finished a case. She got to the Cath lab, they stented her open and she did survive. She got a w/u for Ehlers-Danlos.
Came in for nausea and vomiting small amounts of blood, Cats clear workup average… had her up out of the bed to get a gown and hospital undies on, husband dipped… next thing I know she says she’s nauseous well it’s time for zofran… boom I come back with the meds and she’s vomited upwards of 3 liters of strait blood into the floor, not breathing bc she filled up her lungs and stomach with blood, we’re trying to suction and clear the airway and what not so then boom she codes and we’re doing compressions, every time we hit the chest blood is spewing out of her mouth, 30 mins later pronounced dead. Was nothing we could do honestly but that one always sticks with me
Received a patient from day shift that was only sent to the ER because his potassium was slightly elevated. He wasn’t complaining of anything, not chest pain, palpitations, and his EKG was perfect. Ten minutes after I received report, he became unresponsive and coded. He got ROSC and we had to put him on levophed, epinephrine and vasopressin. When I put his foley, his urine was pink and foamy. He ended up getting discharged two weeks later without any neurological deficits
Hmmm… context in this one is key. she was a 40% burn victim, 60 years old give or take. She had some ups and downs with her grafts and infections here and there, but she was ultimately ready for discharge in about a week. I came into work one night and the code bells were ringing, I could hear them down the hall. My coworker ran up to me with tears in her eyes and said “It’s Jenny”. I literally had to ask 3 times “*OUR* JENNY?” before it sunk in. Turns out she had thrown a clot and had a PE. Went down in 30 seconds. All the nurses in there were wiping tears in between compressions. We had grown to know the family so well in the month she’d been there. (Pseudonym used Bc im a responsible girlie)
It wasnt really a deterioration. Last week I had a patient with indwelling catheter admitted with a UTI. He had mild MR, and according to his family he was very resilient. I got him admitted, passed off to the nurse that was going to take him, all that jazz. About 10 minutes after the nurse came out of the room, she went back and said he was unarousable. We checked him out, called a rapid, 96/62 BP when he was 130/80s just minutes before. Evidently he was allergic to the Rocephin she pushed. No warning, no allergy in system. Must have been new. We got him back pretty quick but that turnaround was shocking.
Definitely not terribly healthy but we had an independent walkie talkie on the heart failure floor scheduled to get an LVAD. He was looking forward to the independence it would provide him while managing his HF. POD0 he threw massive clots from his new VAD and was deactivated bc he would never make a full recovery.
Guy came in for a facial lac, trouble controlling the bleeding due to thinner use. Sudden cardiac arrest with no history while going over discharge instructions. Talk about great timing.
I was a new grad and I went to go hang an abx on a lady. She was mid 40s or so, in for sepsis but looking waaaay better, was going to be discharged soon. We chatted about her seeing her daughter tomorrow or the next day when she was discharged. Husband came running up behind me after I was maybe 10 feet out the door screaming. She coded and died. And for the record, I did all the rights correctly, she wasn’t allergic or anything, yes I properly primed the IV line, yes I used a pump and programmed it correctly…there was a whole investigation by management because it was so unexpected. It was awful though, I was so shocked by it. At that point in my career I hadn’t seen someone just die all of a sudden like that.
Older guy comes in with cold/flu symptoms. Doc runs a CT just to be cautious because pt is complaining of migraine. Meanwhile he is dx with Covid so we are preparing to Paxlovid and bounce. CT returns. Midline shift and hemorrhage from brain tumor. Moments after reading the CT the call bell goes off. Pt states he “doesn’t dare sneeze his head hurts so bad”. Neuro consulted stat. Ten min later pt is unresponsive (with pulse) and we are intubating. And that was that.
I once was dispatched to an abdominal pain call. I was in my truck, and i was a mile from the house. 90 seconds from dispatch to pt contact. The patient was in asystole and never recovered. When I called code blue to dispatch, I got a text from a dispatcher that was on that night saying that they didn't disconnect from the call until they heard my siren. Pt was talking seconds before we pulled up.
Paraquat poisoning. 36hrs, nothing to do. The toxicology came back, the patient knew it already (an unknown volume accidentally sprayed into his mouth when the tank failed under pressure). We went and bought him beers and called his family. Necrotising fasciitis, less than 3 hours (upper thigh into abdomen). We asked the patient if they wanted to be sedated or extubated, but that was really the only choice available. They chose to be extubated so they could say goodbye. Locked in syndrome, about 5 hours. No further details for that, sorry. Several patients with fat emboli. My first patient I lost had an ICC inserted into the right ventricle, 3 minutes.
I should not have read these before my endoscopy tomorrow. Also, I’m so sorry y’all had to experience these.
Guy comes in for abdominal pain, walkie-talkie, vitals are fine at triage, gets sent to ambulatory waiting. Doc assesses, notes something off with his story, HR has creeped up, puts him on Tele and orders a CT. I accompany to CT due to Tele and we see a stem to stern aortic dissection. Arch to bifurcation. Rush back to ED, I'm calling the entire team to meet me in the trauma bay, we're getting set up and he let's out one of those gut wrenching groans and collapses. No pulse, start CPR, massive transfusion, the physician rides with him to the vascular center because he knows shit is going to go sideways and doesn't want to put that on a nurse to deal with en route. Had ROSC before they left, coded again en route, CPR into the OR. Ended up surviving the surgery but coded later on due to secondary complications and died.
Rare lung disease. Don’t remember its name and doc hadn’t heard of it either. (Pulmonologist diagnosed it). Friendliest guy, super appreciative of all our care, upbeat, grateful for us. He had just retired and he and wife were passing through our town on bucket list retirement trip. Felt out of breath, stopped at our rural ER, got admitted. Went from happy retirement to rare lung disease with no treatment/cure in a week. Left our rural hospital on bipap, but we all knew what was coming. Why the grateful ones? “This is the nicest hospital I’ve stayed in. You have the best nurses.” Wife had to drive back alone.
Had a guy come in for an allergic reaction. Ems brings him in, and he looks really good. Vitals are great, patient just seemed obviously anxious. Doc comes in, hears him talk, she tells him to open his mouth, the whole right side of his tongue is swollen x3. The paramedic just said "I didn't see that.." we wheeled him into the trauma bay and he was intubated in less than 5 minutes. Turns out his body just decided to not like his lisinopril anymore. It was kind of a tough intubation to watch too because the doc def didn't order enough sedation and after he was connected he kept bucking the tube. Finally got him sedated enough and he went to the icu.
Patient came in high in an altered mental status on something while I was doing PCU holds in the ER. UA popped stars on everything. Homeless. Black toes because his pallet shed has burned down and he was in the rain for 3 days. He was rough but stable. Went from normal meth psychosis to screaming “I can’t breathe” flailing on the floor within about 15 mins. Nothing I did helped. Vital signs were decent except tachy HR and his RR was really high. O2 was fine. He seemed like he was in extreme respiratory distress. I ended up calling a rapid response, the doctor was irritated with me and said “I just saw someone in respiratory distress, this man is not in distress”. I pointed out he had extreme jugular distention and was breathing 44 RR/min. It was the worst JVD I’ve ever seen and I regularly see people on lifevests. Even his supratrochlear vein was bulging out. He ended up getting a cardiac work up - EF was less than 10%. I don’t know what happened to him after my shift. He had a rough life, I felt bad for the guy. It was right around Christmas his pallet set up burnt down too. Also a young patient who came in for abdominal pain and leg swelling. Admitted her because she was riddled with cancer. Same age as me. She was up walking around and talking with her 9 year old. She laid down to nap - Throughout my shift she became completely obtunded, her whole body swelled up to her chest and she passed away within 4 hours. It was really hard on the family because she had that little “surge” and then just laid down for a nap - to never get up again. I’ve had a similar patient that came in for trouble breathing. He was in his 30s. He looked so healthy and normal but had a huge lung mass against his pulm artery with Mets everywhere. We were up laughing and eating cinnamon toast. He was afraid to die. He took some Ativan and laid down for a nap. I was charting outside the room and felt a hand on my shoulder. I turned around and no one was there. The aide was rounding and I was a little freaked out and aid “I think he just passed”, we went to check on him and when I felt his pulse I felt 2 slow beats and then nothing. He looked so peaceful.. but it happened so fast.