I had my first true patient emergency the other night. It was not something that I hope to repeat any time soon.
My patient had type I diabetes & their blood sugar was very difficult to control. They also had end stage renal disease requiring dialysis 3 times a week. When I got report from the off going nurse I was told the patient didn’t have IV access. Apparently they pulled their IV out the night before & despite multiple attempts, no one was able to establish a new line. Starting IV’s on dialysis patients always tends to be challenging. I was also told that they were a diabetic & we were to check blood sugars before meals & at night.
When the shift started their sugar was 500 (normal is 60 – 100). I looked back at the patient’s blood sugar readings for the past 24 hours. They had been running high all day, but nowhere near 500. The night before their sugar was around 400 at the beginning of the shift & dropped down to 89. It’s fairly typical for sugars to drop in the early hours of the morning.
I also looked at the amount of insulin they were given each time their sugar was high, & how it had affected their sugar the next time it was checked. It seemed fairly normal for the patient’s sugar to run high despite how much insulin was given.
I called the doctor to see what he wanted me to do. He gave me insulin orders that seemed very reasonable for the patient & the situation. I administered some fast acting insulin as well as some long acting insulin around 10:30pm. I rechecked the patient’s blood sugar around 11:30pm & it was 450. I checked it again at 1:30am & it was 91. At that point, the patient was alert & oriented. They were resting in the bed & did not want anything to eat or drink.
I didn’t think much of it since it’s typical for blood sugars to drop some during the night. Plus, I was taking into consideration how their sugar dropped to 89 the night before with similar insulin administration.
Around 2:15am I was checking on everyone during my hourly rounds. I immediately knew something was wrong when I looked in my patient’s room. Their once unruly hair was now matted down to their head & soaking wet. They were shaking & making a grunting noise. It was a sight I’ll never forget.
When you find one of your patients in distress, you brain goes back to the basics. I sprinted to the nurses station & grabbed a Glucometer, some oral glucose (sugar gel), & some IV supplies. I also yelled that I needed help & a set of vital signs for the patient. Another nurse & a patient assistant came running.
I attempted to check their sugar but the Glucometer just read “LO” which means it was less than 40. The patient wasn’t responding to their name but they would withdraw & moan in response to pain. The other nurse started to squeeze the sugar gel into the patient’s mouth, but they wouldn’t swallow it. As I picked up the phone to dial the code my fellow nurse attempted to start an IV…unsuccessfully.
As the alarm started blaring overhead, I remembered the patient was a dialysis patient. They had a perm-cath that they got dialysis through which meant I had a possible line going directly into their blood vessels. Floor nurses aren’t supposed to access dialysis lines, but all I saw was a way that we could get some sugar into the patient – fast.
Again, I sprinted to the nurse’s station & grabbed an amp of D50 (pretty much a thick sugar-water). As I started to push it through the dialysis catheter the doctors, nurses, & respiratory therapists started to arrive in response to the code that was called.
The doctor who gave me the insulin orders arrived just as the patient started coming to. After examining the patient he said, “Well, I guess we gave her too much insulin.” I looked at him & said, “Ya think?!?”
Before I pushed the amp of D50 the patient assistant had been able to draw a vial of blood to send to the lab. The patient’s blood sugar was 10 when I found them. TEN. Who knows what I would have found if I had done rounds 15 minutes later…
I am thankful that I found them when I did. I am also thankful for my fellow nurse & assistant who helped me out. They kept me cool, calm & collected…at least as much as humanly possible.