I had that instinct they always talk about....

A cute 60 something woman came over from the CV/ICU mid-afternoon. She looked good, post operative day 2 . . No major issues to be reported. I settled her in, did a thorough assessment, oriented her and her sister and then continued my afternoon as usual. A few hours later I was in her room talking with them and she just seemed a tad different. I couldn't put my finger on it but it was her eyes that told the story. They had this glazed look to them and were not focusing quite right. I did a rapid neuro assessment and she checked out fine. I just didn't feel right about her so I called my charge nurse in to do a neuro assessment herself. The woman checked out but seemed a little drowsy and the family agreed that this was abnormal for her. We thought about her being a dialysis patient and having received Percocet prior to coming to us. Was this influencing her metabolism of the pain medicine and maybe contributing to her drowsiness?

About 5-10 minutes later the monitor room called to tell me her heart rate had dropped from the 70's Sinus Rhythm to 49 and was now riding in the 60's. I had just left the room and she was unchanged. I checked it out on our monitor and she was Sinus Brady. She had had no rhythm issues prior to this. I reviewed the past rhythm strips and they looked good, so I concluded this was abnormal for her and something was changing. I told my charge nurse and asked if she wanted to put the monitor and pacing pads in the room. She said " let me call the ICU nurse who previously took care of her and ask some questions and we'll watch her close".

I walked back into the room and found she was not arousable, her eyes were wide open and she was barely breathing. I called for a rapid response while the other nurses grabbed the code cart. Her respirations were agonal at this point so we started bagging her. We hooked her up to the monitor and put the pacing pads on her. She was in Sinus Bradycardia. We tried to get a blood pressure and couldn't , they called it "Code Blue". We accessed a strong femoral pulse as people started pouring in to help. The code team , ICU nurses, medical residents, anesthesia and their students , respiratory, the AOD and chaplain. We had plenty of hands, as always in a code.

Still couldn't get a pressure as I tried to explain to her attending physician what was going on. Of course he was frustrated and demanding more information than I had at the time. Eventually he got the picture. I think part of it is that he knows I'm a new nurse and thinks I am incapable in some way. At least that's how I feel when they get all stressed out with me on the phone. Oh well that really wasn't important, my patient was. He ordered her be intubated and taken back to the ICU. Eventually, we got a pressure, a really crappy one and she was headed for the ventilator and some pressors. Days later I talked to one of the nurses about it and it turns out the patient had Sick Sinus Syndrome and needed a pacemaker. So... It was a good assessment on my part and we had done nothing wrong. She received the right treatment in time and is doing quite well now. Another learning experience on my part. TRUST YOUR GUT!