Alex Holcer, RN, BSN, CCRN

We recently had a patient in the ICU who had ingested dangerous amounts of a medication and progressed to being intubated. When Alex arrived at work later that evening, she was taking report on the ICU patients as the rapid response nurse for the night. We began talking through this patient s story and how traditional interventions were not treating the patient s acidosis or controlling arrhythmias.

Alex began to question what the rationale was and why these interventions weren't providing the correction they typically would. Immediately, she began researching the ingested medication and found peer-reviewed papers and studies that identified the progression of symptoms with this type of overdose.

While we finished the rest of the report, Alex went out to speak to the intensivist for the night and questioned if he was aware of the findings in the studies she found. She advocated that the patient had progressed through the stages of this overdose and that we had reached cardiotoxicity and the patient would need VA ECMO to survive.

Alex and the provider talked through the patient's clinical condition and symptoms while she continued to advocate for a higher level of care. Alex asked for a bedside echo to be completed to evaluate cardiac function and if the patient had evidence of systolic heart failure or reduced ejection fraction.

The intensivist agreed and performed the bedside echo, where he discovered the patient did have significant bilateral atrial enlargement and extremely reduced ejection fraction. At the request of the intensivist, Alex began gathering phone numbers for hospitals with ECMO capability and, after finding an accepting facility, had already arranged for Life Flight Eagle to transport the patient.

Alex moved quickly and didn't miss a beat or waste a second of time during this process. Along with advocating and working on the transfer, she set up a monitor to allow us to view and utilize the patient's hemodynamics in real time to help us make the best decisions for the patient and kept the patient's mother updated while at the bedside.

She spoke to the mother with so much kindness and compassion during such a scary and uncertain time. Alex told the mom exactly where we were calling for transfer and what the backup plans would be if the first facility had declined. She wrote down the transfer hospital's address, the new room number, and texted the mother directions on how to find the parking garage and new ICU the patient would be transferred to.

When Life Flight arrived to transport the patient, Alex escorted them outside and called the patient's mother as they were taking off and gave her an update as to how the patient was doing and explained what the timeline might look like once the patient arrived at the new hospital.

Alex wasn't the primary nurse for this patient, but she is the reason the patient survived. To put things into perspective, we first learned about the patient at approximately 7 pm, and because of Alex s efforts, the patient transferred to the new facility at 11 pm.

Four hours of extremely intense work by everyone involved in this patient's care, but Alex set it all in motion. She is truly a remarkable person and nurse; we are all so grateful she is on our team, and we have the opportunity to learn from her.