Horror Story.... from NH.

[cosgrojo]

Got called to a nursing facility today for a priority 3 patient that needed to go to the hospital for a foley catheter change. The facility took a 1 hour ETA because they stated that it was non-emergent. Facility states that the patient was evaluated by an RN and he simply needs his catheter swapped out because he isn't voiding. We arrive on scene, get report (not a lot, because the nurse hasn't actually stepped in the room to see the patient), and then go see the patient. He's purple, mouth open and snoring, eyes unblinking, staring at the ceiling. Urine in foley is grey and clumpy, has been for many days. Foley hasn't been draining, they tried flushing it once.... got some blood clots to drop out (yesterday), and waited to see if it got better.

I ask, "Is this his normal color?"

RN replies, "No."

I ask, "Is this his normal mentation level?"

RN replies, "No, he's demented, but normally speaks with us."

I ask, "When was the last time he was able to speak?"

RN replies, "Yesterday afternoon."

I think, "Crikey!"

I ask, "What was his last set of vitals and when were they taken?"

RN replies, "116/72 with a pulse of 76, temp of 99.6, 94% RA....... and that was at 0845."

Well it is now 1230..... We take vitals... 60/40 with a pulse 136 weak & thready (carotid... no radial pulse attainable), temp 102, 88% RA.

I ask, "Does he have a DNR?"

RN replies, "Why?"

I reply, "'Cause we're gonna' need one!"

RN: "I think so... let me check..."

Me: "No time... bye."

In truck, partner puts an 18 gauge in Left forearm and a 1000 bag wide open. Dump the whole thing into him in the 4 mile transport, B/P got up to 70/46. BS of 511, 4 lpm got him to 94%. Monitor showed rapid A-fib.

In ER, they dropped another 1000 bag NS, B/P still <100 systolic. His color is better, he isn't as hot and flushed, he's started to blink his eyes. Talk to MD, he asks me about DNR, I say maybe... He smiles and says, "Foley change, eh?" (and no, I don't think he's Canadian.) I reply, "Run 'o' the mill Doc..." Doc says, "He's not leaving this ER alive..." We shake our heads simultaneously and pray that our loved ones never end up in that place.

And yes.... the man died 2 hours later.

[Ridryder 911]

Sounds like a typical day........ for the past 29 years in EMS. I have not seen much differently. Unfortunately, this scenario happens everyday to thousands daily.

People, usually put the geriatrics into nursing home to die. Until, the Americans learn to have a different behavior this will continue to occur. But, I doubt it will .. it will get worse instead of better with the increasing number of geriatrics and immaturity of some younger people... look at grandparents taking of the children now..

Be safe,

R/R 911

[buckeyedoc]

Unfortunately, not uncommon at all.

[xselerate]

ive had tons of nursing home horror stories but this one takes the cake...

we got a job for a g-tube change. we walk into the room and this nurse is holding an albuterol treatment over this womens face. the women is in respirtory failure... at the front door of arrest. We immediatly began ventalating her... no radials... little bp to speak of.... shocky shocky shocky. she was on a vent 10 minutes later... dead 2 hours later.

[cosgrojo]

Agreed... not uncommon, just the most recent one I have to share. If we all told our bad NSG home stories, we'd shut down the site with overload.

[temsp40]

Agreed... not uncommon, just the most recent one I have to share. If we all told our bad NSG home stories, we'd shut down the site with overload.

Absolutely! But it is not JUST the nursing homes....

My all time favorite call was one where I just taken a patient from the ED back (literally) across the street to the nursing with a trach patient who decided it was time to quit breathing altogether. As we return the patient to the ED, I am of course ventilating the patient BVM to trach tube, one of the ED nurses says to me "well, stop bagging her so that I can make sure that she really isn't breathing." So as I stop bagging this patient (who simply is not breathing) my little brain is racing and thinking -- ok, I know I am just a stupid little basic who works for AMR, but I can sure as sh** tell the difference between a breathing and not breathing patient, especially when I watched this one stop breathing in the ambulance I says to the nurse after about 30 seconds -- "See she is not breathing and I am going to begin ventillating her now." At which point all heck breaks loose and they start screaming for respiratory and a vent and all of a sudden the stupid AMR crew actually knew what the f--- they were talking about.

I wish I had known about Bill Engval back then, because my reply would have been something to the effect of:

"Let me demonstrate for you the difference between breathing and not breathing"

Squeeze, squeeze, squeeze "Breathing"

waiting waiting waiting "Not breathing"

Here's your sign

[brock8024]

This is what is sad. This patient from what you said had went into irreversible shock. I mean if you was to ask most nurses or any medical person the definition of shock and I would hope that at least 90% could tell you. It is sad that most do not know how to catch shock before it goes to far. And I love how the pt is always OK a hour before you find them. this just makes me mad because this guy did not have to die because of this.

[hammerpcp]

Yes this is not an uncommon situation, but we as a profession should not learn to accept it as the norm. The public is generally unaware of the substandard treatment waiting for them when they are too frail to tend to themselves. Otherwise somtething would be done about it. Write them up. We are in the best position to instigate change.

[weasel 108]

I Was dispatched 911 to Nursing Home for "emergency Transport" some time ago.When we arrived at the room,Nurse? :roll: , was sitting on the back of chair reading newspaper, :shock: Pt was a beautifull color blue.(they broke one of my rules :x ) :roll: ,anyway we did CPR,& trans. to Hosp (aprox. 3blocks).Pt survived :shock:I have had a few intresting calls since this incident at some of the other nursing homes in our coverage area.

[Nate]

I've ran three day old codes, nothing surprises me when a nursing home is involved.