Doctors and nurses, what was the most unusual patient code situation you've seen? Did the patient survive?

As an ER scribe, I followed physicians on all calls and recorded the details of physical exam, treatment, diagnosis, etc. One evening we had a lady in her late 50’s come in via ambulance unconscious. Per the history, the patient had been tested at home and found to be hyperglycemic (high blood sugar) so the daughter had given her around 10 units of insulin and called an ambulance (pt was unresponsive). The ambulance arrived and took their own blood sugar reading, which still showed high, so they gave more insulin. Upon arrival in the ER the EMTs were unsure why the patient had not yet regained consciousness, and their blood glucose monitor still showed her as having an elevated reading. Our doctors took their own glucose reading after the hand-off, and the glucose was 8. EIGHT. A normal glucose is 80–120. Low is 40–60. 8 will kill you. Why wasn’t this lady dead? She was on an LVAD. LVAD= Left Ventricular Assist Device. This machine basically pumped her blood for her. In a healthy human a glucose of 8 would have stopped the heart (no fuel) and damaged the brain (no fuel or oxygen). This woman, because she was waiting for a transplant and couldn’t use her own heart, was able to survive because the machine didn’t care about her glucose levels (oxygen kept flowing). 50 grams of Glucose were given via the carotid artery, and she regained consciousness a few minutes later. The doctors mentioned something about the EMTs needing to calibrate their glucose machine… (One of the three scariest things I saw during those 6 months as a scribe.

What are some important facts about midwifery?

The most important facts about midwifery is that trained midwives have the same good outcome statistics for mothers and babies as doctors when it comes to healthy mothers and babies, but a lower c-section rate, a lower episiotomy rate, a higher satisfaction rate, and are the best buy for health care dollars. Midwives are experts in the normal and guardians of the normal. They are highly trained to screen for anything outside of normal. Doctors are trained to be experts in taking care of the conditions that are outside of normal and are essential partners to good midwives. Midwives know how to take care of women and girls throughout the life-span, from puberty to menopause.

It is important to learn about the training of the midwives in your area and the laws in your state regarding midwives. In most states, Certified Nurse Midwives can attend births in hospitals, birth centers, and homes.

They can also prescribe medications, order lab tests, order ultrasounds, and do routine pap smears and annual exams. Certified Professional Midwives do only prenatal care and births in birth centers and homes. Both are more likely to spend more time with a woman at each prenatal visit, give more individualized education, be present and more high-touch during labor and birth than doctors have time to do.

In most cases, Certified Nurse Midwives are covered by your insurance. Even birth centers are covered by some insurances. Birth centers are lovely safe places to have your baby where it is like having your baby at home but the midwife has all the equipment she may need right there. There is room for your family and friends to hang out and eat and visit. Home births are where you have total control over where, who, and how you birth but the midwife has to bring all of her equipment with her. For both birth center and home births, there are about 30% of women who will screen out of the ability to birth there and that is why the average birth center has only a 4% C-section rate. Emergency transfers for all complications are always available. Some birth centers are attached to the hospital and are more liberal about who they will allow to birth there.

Do your research about the safety and skill of midwives. You will find that there are wonderful midwives in many communities who want to work with you to make your birth experience as positive as possible. If you cannot find a midwife within a reasonable distance for where you want to birth, strongly consider getting a trained doula as they can make a big difference in your experience and your outcome also.

Do nurses find taking vital signs a menial, unnecessary task?

The new modern obs machines are easy to operate (even a Doctor can do it and Doctor are generally fairly rubbish at using ward based machines!) however the skill comes in the interpretation of the readings.  

physiological parameters need to be viewed in patient context ( i.e people with lung disease may always have low oxygen levels) and trend changes also should be tracked. These measurements and trends can track if a patient is unwell, or becoming more/ less well; in the vast majority of inpatient cardiac arrests you can track the patient's deterioration over the preceding hours on their charts. 

In the UK we use the obs (observations) to create a score (MEWS,SEWS etc Etc) to either trigger an immediate medical review or to track any changes. This allows assessment of either deterioration or response to treatment. 

Depending on staffing ratios, ward activity and hospital/board policy it may not necessarily be a staff nurse who actually takes the obs- it might be a nursing student, a clinical support worker or auxiliary. There will then be a policy of escalation of abnormal or changing readings being fed up the chain to the staff nurse responsible for that patient and then the senior nurse on the ward.

For more Info: https://www.quora.com/Do-nurses-find-taking-vital-signs-a-menial-unnecessary-task