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- Apr 1, 2004
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At 0445 one of my patient's BP dropped out to the 70s and he was ashen and diaphoretic. He had finished dialysis at midnight. He was a full code in spite of ESRD, CABG (twice), Bilateral Carotid endartectomies, AAA, etc, etc.. I dropped 250 ml of fluid in him and put him in reverse trendelenburg. Finally got the doc who was covering for the attending. Called him back twice and he advised me to call the renal guy. He also advises more fluid. We still can't keep the guys BP over 80 when we level out the bed. I page the renal guy who is covering for the renal doc who normally sees the patient multiple times and he never calls back. Charge nurse and respiratory therapist are helping me with the patient while I do all the calling. I call the doc covering the attending to see if he wants to do anything else. I told him I'm calling the Hospitalist and he agrees. They come up, check out the patient and think that he will be allright where he is. BP is still labile. The crisis nurse has a Dopamine drip ready to hang and every one is ready to transport to MICU. I can't do a 1:1 cause I have other patients. At 0600 the regular renal guy resumes call and I get him. He wants SPA hung. Now we're getting somewhere. BP still does not respond. We call the intensivist and he sees the patient, orders 100 ml of 25% Albumin and slaps the patient immediately in MICU. 3.5 hours to finally get a patient where we wanted! Thanks to the other nurses who picked up my patients.