# "uhhh...she obviously has a pulse, why do you think we called?"



## jshal (Aug 30, 2016)

Let me just say I have respect for most nurses and this story does not represent my feelings toward the whole. 

Get called to a nursing home for an unresponsive. found 85 y/o F with serious pallor in apparent respiratory arrest on a CPAP,  lying in bed with two nurses beside her. MOLST above bed.

me: whats going on with the pt?, does she have a distal pulse? 
nurse: uhhhh obviously she has a pulse...why do you think we called you?
me: *checks carotid, pt is cold, takes a better look at the MOLST as partner is getting leads ready*
(DNR, but ok to ventilate if pulse is still present)
ALS partner: *checks carotid, hooks up monitor* 
ALS partner: asystole guys...
nurses: that cant be. this doesnt make sense. 
ALS: if you thought she had a pulse, why didnt you ventilate?
nurse: she was breathing! 
ALS: *contacts telemetry for permission to call it, calls it* 
nurse: *stares off into distance*
Pt's roomate: *looks at us then back at nurses, then back at us in horror*...poor guy.


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## dutemplar (Aug 30, 2016)

Years ago was dispatched for a witnessed cardiac arrest to a "skilled" nursing facility we kept having issues with, with the one staff member.  On the way past the nurse's station I grabbed the chart.

The witnessed arrest slipped out of bed, choked to death in the bed rail.  Rigor mortis and dependent lividity.  According to the notes, she had peaaaaaaaaaaaaaachy vital signs an hour ago.  Weirdest thing ever...


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## Handsome Robb (Aug 30, 2016)

dutemplar said:


> Years ago was dispatched for a witnessed cardiac arrest to a "skilled" nursing facility we kept having issues with, with the one staff member.  On the way past the nurse's station I grabbed the chart.
> 
> The witnessed arrest slipped out of bed, choked to death in the bed rail.  Rigor mortis and dependent lividity.  According to the notes, she had peaaaaaaaaaaaaaachy vital signs an hour ago.  Weirdest thing ever...



The state BON would be getting a complaint from me. 


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## dutemplar (Aug 30, 2016)

Our medical director was deputy coroner... He tended to show up on codes anyways.  This time, we called and asked.  Yeah.


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## johnrsemt (Sep 1, 2016)

dispatched to a Rehab hospital for Resp distress at 0530:

Got there and pt was in full arrest  CPR in progress:  worked him,   intubated,  3 rounds of ACLS drugs;  called Med control, stopped the code.  Turned body care over to the staff with deputy there.

Got dispatched back to same place at 0730:   en route I checked the room number against previous run.  Same room; requested sheriff.   Got to the room and same patient  still had IV's in (clamped off) and tube in place.   CPR in Progress  Turned out night shift told the deputy that they would handle everything, and left if for day shift to deal with (but "forgot" to tell day shift).   Freaked out dayshift when they walked in and found him dead,  didn't even notice the IV's in place,   Airway CNA was trying to bag him around the tube:  (had the tube folded down and under the mask,  had good seal with chest rise)


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## Handsome Robb (Sep 4, 2016)

johnrsemt said:


> dispatched to a Rehab hospital for Resp distress at 0530:
> 
> Got there and pt was in full arrest  CPR in progress:  worked him,   intubated,  3 rounds of ACLS drugs;  called Med control, stopped the code.  Turned body care over to the staff with deputy there.
> 
> Got dispatched back to same place at 0730:   en route I checked the room number against previous run.  Same room; requested sheriff.   Got to the room and same patient  still had IV's in (clamped off) and tube in place.   CPR in Progress  Turned out night shift told the deputy that they would handle everything, and left if for day shift to deal with (but "forgot" to tell day shift).   Freaked out dayshift when they walked in and found him dead,  didn't even notice the IV's in place,   Airway CNA was trying to bag him around the tube:  (had the tube folded down and under the mask,  had good seal with chest rise)



Seriously? That might take the cake on dumbest thing that's happened in a SNF. 

I'm betting they displaced the tube when they were messing with it. 


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## SeeNoMore (Sep 4, 2016)

johnrsemt said:


> dispatched to a Rehab hospital for Resp distress at 0530:
> 
> Got there and pt was in full arrest  CPR in progress:  worked him,   intubated,  3 rounds of ACLS drugs;  called Med control, stopped the code.  Turned body care over to the staff with deputy there.
> 
> Got dispatched back to same place at 0730:   en route I checked the room number against previous run.  Same room; requested sheriff.   Got to the room and same patient  still had IV's in (clamped off) and tube in place.   CPR in Progress  Turned out night shift told the deputy that they would handle everything, and left if for day shift to deal with (but "forgot" to tell day shift).   Freaked out dayshift when they walked in and found him dead,  didn't even notice the IV's in place,   Airway CNA was trying to bag him around the tube:  (had the tube folded down and under the mask,  had good seal with chest rise)




Wow. I agree that is literally the dumbest thing I have ever heard. And like most of us, I've heard and seen some specimens. I mean what do you even say at that point? How do you write that chart and not sound insane by proxy?


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## Handsome Robb (Sep 4, 2016)

SeeNoMore said:


> Wow. I agree that is literally the dumbest thing I have ever heard. And like most of us, I've heard and seen some specimens. I mean what do you even say at that point? How do you write that chart and not sound insane by proxy?



I love writing charts with hilarious situations like that fire the sole purpose that we have 100% peer review of all charts. 

Let's me coworkers enjoy the debauchery they missed and we got to witness. 


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## dutemplar (Sep 6, 2016)

What was fun, back in the day (1999?), was when we wrote the charts on the computer and could print them but not save them.  There was a short, brief window that we did that.

Well, the QI guy was severe ADHD/OCD.  So one day I wrote a chart.  Dispatched for a vehicle accident with entrapment and ejection.  One fatal.  Two volunteer fire departments getting into a fight on scene.  Mother with a mild head injury refusing transport of her child with an arm practically amputated because the other kid was dead in the road and shouldn't be left behind..  Child AMA'd to mom with instructions on how to control bleeding to the local community hospital.  The medical director knew I was doing this.

Printed the PCR, dropped it in the stack, and waited...

The QI guy about had a stroke and was literally twitching reading it.


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## johnrsemt (Sep 7, 2016)

actually the CNA had good tube control with the BVM when we arrived,  good chest rise:  
It was hard not to walk in and yell 'WTF' is going on.
Made sure that we stayed till the police got there, and the ME.   Called med control as we walked in the door for orders not to work him a 2nd time and got a brand new resident that ordered us to work him again;   I hung up and called back got a staff doc with a brain  who wouldn't stop laughing at the situation.

Rehab staff was upset at us at first till they finally understood then they got pissed at night shift.   I understand that the night shift supervisor got demoted and suspended and the room nurse got suspended over that. 

Dutemplar:  I would love to be able to do a PCR like that;  a friend wrote one on a patient (unk age) after a car vs pedestrian for a field C-section.  submitted it up the chain to the medical director who almost stroked because they didn't call for orders.  He got part way through it and called them into his office and was chewing them out as he was reading parts out loud:  then got to the part where the pt was dead, but the baby survived was taken to the vet, and then donated to the zoo.  White Tail Deer.


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## MGoff91 (Sep 27, 2016)

I was sent to a unknown medical or trauma recently and the only information I was given was, "theres just a lot of blood". I was in the Inglewood/Compton area so my first thought was GSW or stabbing...we arrive on scene, FD is already there, medics come out with the 50 yo f,  pinching the bridge of her nose for a "severe nosebleed" that came on after she rubbed her nose too hard...and she was the only patient I transported that day..


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## Froggynoch (May 10, 2020)

johnrsemt said:


> Airway CNA was trying to bag him around the tube:  (had the tube folded down and under the mask,  had good seal with chest rise)



That's insane... How do you become a CNA, work in a nursing facility, and not know how to ventilate with a tube? My sister's trying to become a CNA. I'm probably going to have a conversation with her just to make sure she knows what she's doing, lol.


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## johnrsemt (May 17, 2020)

Froggy;  That was actually the 1st time I ever saw a CNA that could bag a patient effectively.  I couldn't believe she had good chest rise.


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## Akulahawk (May 17, 2020)

Rise of the Lazarus thread...


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## Froggynoch (May 18, 2020)

johnrsemt said:


> Froggy;  That was actually the 1st time I ever saw a CNA that could bag a patient effectively.  I couldn't believe she had good chest rise.


Well, give credit where credit is due, right? If she had said "screw it" because she didn't know how to bag an intubated patient, the patient would likely be dead. I guess it's better to Macgyver a solution and get that chest rise lol


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## Akulahawk (May 18, 2020)

Froggynoch said:


> Well, give credit where credit is due, right? If she had said "screw it" because she *didn't know how to bag an intubated patient, the patient would likely be dead*. I guess it's better to Macgyver a solution and get that chest rise lol


Two things: First the CNA wasn't using the tube. That CNA had such a good mask seal that there was chest rise. If the mask was leaking, there wouldn't be good chest rise. Second, in this particular case, the patient was long dead and had been determined to be dead on night shift. Day shift didn't notice that lots of equipment had been left in place and night shift forgot to tell them the patient had expired and was awaiting transport to a morgue or mortuary...


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## luke_31 (May 18, 2020)

Akulahawk said:


> Two things: First the CNA wasn't using the tube. That CNA had such a good mask seal that there was chest rise. If the mask was leaking, there wouldn't be good chest rise. Second, in this particular case, the patient was long dead and had been determined to be dead on night shift. Day shift didn't notice that lots of equipment had been left in place and night shift forgot to tell them the patient had expired and was awaiting transport to a morgue or mortuary...


Oops


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