My first DKA

I had my first Diabetes Keto-acidosis (DKA) patient. For those of you who are not familiar with this condition, it occurs mainly with those people who have type one diabetes. It is an acute metabolic condition that is characterized by hyperglycemia (we are talking like 400 blood glucose and up), hyperketonemia, and metabolic acidosis. It causes nausea, vomiting, abdominal pain and can progress to cerebral edema, coma and worst case scenario death. The patient will also present with symptoms such as low blood pressure, due to dehydration and a crazy high heart rate from acidosis, to compensate for this acidosis they breathe rapidly. So I am sure you can see what a critical patient this is, in the absence or tardiness of care the patient WILL either end up in a coma or die. I can't say this enough, it is very serious. One thing about the patient is severe dehydrated, like almost 6 liters behind. With such insane dehydration a patient's kidney's with lowered perfusion can also be permanently damaged. The hyperglycemia causes an osmotic diuresis that leads to increased urinary excretion of water and electrolytes, particularly potassium. Sometimes DKA patients are unaware that they even had type one diabetes. What a shock right?

So I get this patient.... I will not go into details because of HIPPA (patient privacy rights). I already had three rooms of patients needing my care...

Right when I felt like I was on top of my game.... This patient comes in with one of the most critical conditions we are presented with in the ER, and he was assigned to my room!

When I first walked in the room and saw this patient breathing rapidly, with a crazy high heart beat and low blood pressure...What a stressful situation.

"AHHHHHHHH!!!!!" I screamed on the inside.

I had to collect myself, stay calm, this patient's life was in MY HANDS! This is not the time to lose it.

"First thing is first, let's put him on oxygen," I thought to myself and immediately put him on two liters a minute. I looked at the monitor, that worked, his Oxygen Saturation was at a normal level.

I didn't touch my nursing notes, I would rather have incomplete notes then a dead patient. ....... "Dead patient," I kept thinking in my head, "nobody is going to die here, not in my room."

"I need help in here!" I loudly announced to the nursing station where the doctor and nurses were intermittently gathered. Two nurses came in my room and one doctor.

"We need some lines on him and labs drawn," I said taking charge as primary nurse.

"We better start the DKA protocol," the M.D. said to me, "I know this is your first time but you can do it, let's start an insulin drip at 5 units an hour and get him 2 liters of fluids stat."

"Sarah, Room 13 needs you." I heard overhead.

"DAMN patients!" I knew exactly who it was and what they wanted. I imagined their whining faces....... "How much longer is it going to be till we can go home?"

"You are NOT the only patient in this ER!! You CAN wait! Now, don't bother me right now for the love of everything that is good and holy!" I answered them in my head while walking to the medication room to gather the necessary insulin for my DKA patient.

"Dead patient....." I couldn't stop thinking...

I will be damned if I am going to stop doing what I am doing to answer stupid questions, I ignored the overhead and proceeded to concentrate my insulin drip. I was at the mercy of the other float nurses to cover every single trivial question and complaint my other less serious rooms had. Surely they knew I would be tied up for the next half an hour or so.

Alot can happen in half an hour.... Mr. E in room 12 can fall off his bed.... I would have to fill out an incident report... Answering all the questions on the computer..Was he in non slip socks, were the side rails up, the call light within reach and how much morphine did he have before the fall? Basically asking. "was it your fault as his nurse?"

"I just gave room 12 five mg of Morphine, I wonder...Are the side rails up?" I thought to myself... I imagined him fallen in a pitiful position on the floor, he looks to me... "if only you would have put the side rails up I wouldn't have fallen."

"AGHHHH!" I screamed on the inside again.

"NO, you have to focus on this now!!" I brought myself back to my critical patient and wheeled the IV infusion pump into the room with my bag of insulin drip.

I started it and the patient's fluids.

NEXT...... "I need lab results." I say to the unit clerk, "like now."

We needed to know how much potassium he lost in order to start replacing it, low potassium can kill.

Within a few minutes I had a print out of lab data.

Thank god!! Potassium looked good. I ordered more potassium in Normal Saline from the pharmacy per the DKA protocol, which I have never done before!

While I waited for the potassium I made sure a room was ready in the ICU for my patient. They had one room left, for codes. It was mine! I called the ICU nurse and gave report.

After about an hour of running around, I finally got my patient transferred to the ICU. It was a good feeling to have the craziness over, and to know that you made a difference, the patient is alive...

I got back to the floor with an empty bed, once occupied by a VERY critical patient. I couldn't believe I handled that situation without freaking out.

I did it...

I am an ER nurse...

I helped save a life....

And thankfully, the float nurse covered my three other rooms. Everyone was okay, nobody fell out of bed or coded on me.