Giovani Alcantara

Giovani Alcantara

Giovani Alcantara, RN

Mindanao Doctors Hospital and Cancer Center Inc.
Health Carousel Philippines
Kabacan, North Cotabato
Philippines
At the ninth dose of epinephrine which was around 1:45 AM, miraculously we noticed a cardiac activity from 32 beats per minute to 45 beats per minute, and at 2:00 AM we are observing a stable heartbeat.

The pandemic has made my work so challenging that sometimes I feel nervous every time I report to my work as an ICU acting Head Nurse. I am also functioning as a Staff Nurse due to understaffing because some of our staff had resigned, and we also have a 24-hour duty.

I have been working as a nurse in a different field of nursing for more than 20 years and I never considered resigning from my work, even now that the risk of getting exposed or infected with the deadly COVID-19 is very high. I believe that as a nurse or an ICU Nurse I can be of great help to numerous patients especially those who are critically ill patients whether they are COVID positive or not. Below is one of my priceless moments as a health care professional.

One day at 2:00 PM one of our patients was been discharged from the unit after her seven (7) days of admission in ICU and transferred to a private room. At around 6:00 PM on the same day, the nurse on duty received a piece of folded prescription paper from one of the family members of the patient which was addressed to the ICU Head Nurse and I was surprised when it was handed to me on the following day at 8:00 AM which was the start of my 24 hrs. duty in ICU. Our ICU is a 3-bed capacity with one nurse on duty for 24 hours and one attendant.

This is what happened:

A 38-year-old Maguindanaon female client was admitted to our ICU unit with the chief complaint of Severe Body Weakness and with the admitting diagnosis of Severe Hypokalemia Periodic Paralysis; Community-Acquired Pneumonia - High Risk; Post Arrest. The patient is intubated, with ongoing different intravenous fluids which are norepinephrine, potassium chloride, and a normal saline solution. The patient was hooked to a mechanical ventilator, cardiac monitor, and oxygen saturation monitor. The patient was unconscious with GCS 6/15. Routine ICU admission care was done and after doing so we are back to our different care activities for our patients. During that time we have two patients, one of them is a patient who suffered a Cerebrovascular Accident (Bleed) and was intubated and the other patient was having a Myocardial infarction and plus our newly admitted patient.

At around 1:00 AM while we were busily suctioning the CVA client, we noticed that the newly admitted patient is having an episode of arrhythmias that in a very short period of time progressed to a run of PVCs that suddenly turned into SVT (supraventricular tachycardia) and arrested the second time. High-quality CPR was initiated after placing a cardiac board and positioning the patient properly, I then asked my attendant to call the ROD (resident on duty). The family was getting nervous about the possible outcome of the second arrest, after the 6th dose of epinephrine, our ROD started to talk to the family that 30 minutes have passed and still we don't have a sign of cardiac activity. The family was losing hope and considering to stop us from continuing the CPR, on that time I am losing energy to keep going because my attendant is a female and she can no longer complete a five cycle compression because of exhaustion and considering that it is already 1 AM and we had been working for 17 hours. The ROD asked me if we can still continue CPR and during that time I am already exhausted to the point that I am almost giving up, but I did not give an answer but the ROD clearly understood the situation. At 1:35 AM the ROD told the family that he will be administering the last and final 7th dose of epinephrine because there is no more hope and the staff are very tired now and can no longer continue to perform CPR, but the family still cannot decide and I can clearly hear the patient's daughter who is a 15-year-old begging and crying for us not to give up because she said she has nothing left in her life that losing her mother would mean losing her one and the only reason to live (the patient is a single parent), so all of a sudden I feel energized and I told our ROD that we will continue CPR until the 10th dose which is at 1:50 AM. At the ninth dose of epinephrine which was around 1:45 AM, miraculously we noticed a cardiac activity from 32 beats per minute to 45 beats per minute, and at 2:00 AM we are observing a stable heartbeat. After getting a stable heartbeat the ROD had informed the family of the patient's response, the family then gave thanks to us and we can really see from their very own eyes and facial expression the joy and hope that their patient might have a second life.

It was a very exhausting night but fulfilling because we have done our job to help extend one's life which is a very common scenario in ICU to encounter such an incident. That night was very different because usually as our practice in our hospital we will perform CPR not longer than 30 minutes and that night I decided to continue for more than what we used to do hoping to extend one's life. Miraculously we were blessed that we got what we fought for.

I am so thankful and blessed that I choose to be a nurse and I believed that God put me in this profession for a reason. I am sharing this experience of mine to inspire other nurses around the globe who might be able to read this story.