I just came back from a very painful memorial service of a close friend father figure who died recently due to what I call negligence.
Remember that I am a critical care nurse and while I understand sometimes things might get tough, negligence looks and sounds like nothing else. Unless proven beyond reasonable doubt that it was unavoidable circumstances that lead to death.
This patient I am talking about started having chest pain at home and the family called 911. Done and within no time, the EMS was there and everything that seemed right was just about to go really wrong.
The EMS took the patient to the closest capable ER and en-route, they were unable to start an IV! Say what? A STEMI patient en-route to the hospital, the EMS were unable to start an IV to save this man’s life.
So what? The EMS got the patient to the ER while still able to talk and communicate. The patient coded inside ER the first time and the ER team was able to get him back – WITHOUT AN IN ACCESS UNTIL THIS POINT.
The patient was able to talk to the son, who happens to be a nurse and said a prayer with him. Told him… Son, I love you son… Asked God…”If there is something I have wronged you with God, I repent. Forgive me God”.
He coded the second time – WITHOUT ANY IV ACCESS – and they were able to get him back. I am sure ICU, ER and EMS nurses reading this are wondering….WHAT HAPPENED ABOUT INTRAOSSEOUS ACCESS? Nope – none of that. They never did and the least they tried was a Jugular access.
This time he coded the third time and he went to be with the Lord. He died! I want to not think about this with hard feelings but what explanation does the EMS & ER team has letting this patient die due to lack of IV access?
Help me here, reason with me my dear nurse!
Put yourself in this family situation. They just wrongfully lost their loved one at a young age of 68. If you were the family, would you seek legal restitution?
Would you accept this death was due to natural causes beyond human intervention?
Here are my contention points:
- EMS responded on time and recorded 2 IV misses. They arrived to the hospital before they could get it. – Did they consider IO access?
- The patient arrived in the ER talking and coded the first time. CPR got him back – still no IV access. Can I get an IO access please? He got back and prayed with the son. He talked to God.
- The patient coded the second time and they were still able to get him back without an IV access. He still had a chance if they had an IO access. He got up and talked, again but still, no one did an IO access. They tried a Jugular access.
- The patient coded the third time without an IV access, the jugular they third didn’t work. The patient this time did not make it. He died
I stayed up re-reviewing the algorithms of such an even. YES, EMS has all the reasons to insert an IO access. But they did not.
The ER committed an act of gross negligence here. Or at least I feel like they did. They were unable to establish an IV access but they did not try alternative IV methods – IO access.
Would you have tried an IO access?
Let’s her your opinion?
Leave a comment below and I will appreciate.
Thank you
I don’t know his risk factors but a stemi with arrest that fast after symptoms had a poor chance to begin with, usually left main disease. Survivors of this can suffer free wall rupture, severe chf including fatal carcinogenic shock, recurrent vtach etc. Tpa may have been life saving in the short term but it is obviously inferior to pci and would have precluded that and put him at higher risk for the above. I think it might be easier for all parties to accept the fact that his heart was sick and that his time came earlier than everyone hoped and his death was at least quick instead of prolonged in a cardiac icu with a tube in every orifice after 2 weeks.
I agree on the mortality chances were high but not starting IO access made me feel like the patient had a fighting chance.