ED Chart #1

due to HIPAA, names and locations will be edited to protect those involved.

about an hour into my shift we recived a elderly pt. who is presenting with severe COPD (chronic obstructive pulmonary disease) she also had a tracheostomy,and the stoma (the physical hole in which the tracheostomy as applied too) looked and smelled very infected. the tubing has loose and the MD wanted to replied. also due to the physical presenting factors, the pt. breathing was labored and painful. the pt. had fluid build up and mucosa build up so RT (respiratory therapy) can and suctioned off about 200 ml of fluid, and gave the pt. a breathing treatment.

x-ray swung by to gather data and my self and RT worked on her. i drew her labs as RT tried to negotiate the tracheostomy back into working order. it just would not fit in, and it hurt the pt. the stoma had necrotic tissue all around externally and what i could see, internally as well. if touched, the dead tissue would sluff off a bit.

this was all uncharted and untreated while the pt. stayed at a nursing home, or adult home.

between the time i wrapped up on labs the the last time RT suctioned the pt. it all went wrong. from a pt. responding and smiling to the moment in which she gaged coughed and from the corner of my eye, caught what seemed to be shinny red fireworks...it was not, from the pt. stoma sprayed, with every heart beat, ruby red blood, four foot long spurts. i cover the pt. stoma with my hand, while grabbing suction, RT called out the door and the admitting MD and staff rushed in. i suctioned blood off, then punched off what ever ruptured in the pt. trachea.

MD: move your hand.

me: it's bad.

MD: move your hand.

i did and again blood spurted out, the MD moved in and felt around.

MD: more suction, i need a intubation kit! more suction...

while all this was going on, the pt. spouse was standing at the door, watching all of this go on... nurses quickly walked him out. he face, burned in my memory.

some body then came back, with the pt. chart and stated "DNR" (do not recesitate)

efforts ended, except for suctioning and positioning...

blankets were placed to cover the pools of blood on the pt. gown. blood was wiped from the pt. face and what blood that made it to the floor was moped up just in time to let family in...

they went right up to her...

"we are here momma, we are here"

one looked up...

"can she hear me?"

it takes the human body about 3 min to bleed out, but seconds when ones lungs are saturated with blood, and when one cant breath, not enough O2 reaches the tissues that need it...every thing comes to a halt fairly quickly in these situations...

"can she hear me?"

RN: as nurturing as any good mother " Of course, she can..."

the MD already called time of death 1820, family was at the pt. bed side at 1822...