NOC shift and calling the MD

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    I am a relatively new nurse, and I had a pt that developed chest pain during the night, we got a stat EKG and it was better than the previous one on admission. He has a hx of chest pain at home. I continued to check on him during the night and then I got a page that his HR was high. I went and checked on him and he was having a bowel movement. I got the patient back in bed and I walked out to the desk and i get a phone call from telemetry saying he had a 3 beat run of v-tach. I had another nurse come in and assess him with me and asked his opinion on if I should call the MD to get cardiac enzymes... He said with the hx not to call the MD. I relayed this information to the oncoming nurse and she acted like I was completely incompetent and like I just sat back and didn't care. His HR jumped up again that am after I had left, but it was soon after the pt had moved from the bed to the chair. I know I am supposed to ask and use the guidance of my colleagues, but I don't want to fail my patients. What is the best advice?
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  3. 8 Comments so far...

  4. 5
    When in doubt, just call. Do something rather than not is my advice. I dont care what time is it, if your gut tells you that MD needs to know this change of status you pick up the phone and call. WORST that can happen is MD yells, but your license remains intact is super priority next to your patient's well being.
  5. 0
    Check with other RNs, including your charge nurse.

    You will learn when and when not to call and what the MDs need to know at 3am and what can wait until morning through more and more experiences like this, but for now ask your charge and go off his/her opinion and experience.
  6. 0
    I agree with the above posts.. When in doubt or don't know what to do- make the call.
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    Per our unit protocol, we had to call the MD with V tach runs of 6 beats or longer. Does your unit have a protocol for this?

    For chest pain, out standard orders were to get an EKG, give SL NTG x3 (if BP was OK) and call the MD if the 3 NTG did not relieve the chest pain.

    And when in doubt, make the call...
  8. 1
    If you think you should call, it probably means you should....You are there for your patients... NO ONE wants to be woken up in the middle of the night but that is the price they pay for being the MD on call.
    turnforthenurseRN likes this.
  9. 1
    Chest pain- even with a history at home- I normally call. I once had a patient with chest pain, EKG and vitals were WNL. I called and the MD ordered maalox and APAP, it didn't help. I called again, got reemed, and he begrudingly ordered a CXR & CT, turns out the patient had multiple PE's- acute and subacute. You just never know. I have no issue waking up the doctors and like everyone has said, if you think you should call- call.
    NutmeggeRN likes this.
  10. 1
    On my floor, chest pain warrants an EKG. Depending on results (ST elevation/depression, third degree heart block... changes that are bad - call M.D. and probably prep for Cath lab.) If no change on EKG, 3 sl nitros. Then morphine if still unrelieved every 5 minutes. If still hurting, we have a nitro drip protocol we can put in place. Of course bp and other vitals must allow. I've yet to have a patient be unrelieved unless EKG changes were present. Of course most of the time the patient is already scheduled for a Cardiology or LHC.

    Seek advice from your charge. Follow p&p
    CCL RN likes this.
  11. 0
    Where I work, the MD always has an order written that states, "obtain EKG if patient has chest pain and notify MD STAT." So we always call. When in doubt, call the MD. The worst that could happen is they get mad at you. Seek advice from your charge nurse or more senior nurses on the unit.

    There could be other reasons why the HR kept spiking up like that. Was the patient febrile? Hypovolemic? Of course pain will cause tachycardia along with anxiety. Were they hypoxic? One of the first interventions that we do if a patient has little runs of V-tach (besides notifying the MD) is giving them some O2. What did their electrolytes look like - too high or too low? Just some other things to consider.


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