how to make it clear when call doctor - page 2

by neurontin

5,699 Views | 17 Comments

the pt i had last night had a. fib, HR went to 130; due to he had had a.fib two days ago so that i did not call doctor at 0300 am. plus, pt was asymptomatic. when i called the doctor later, i tried to make myself clear by... Read More


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    I am a nursing student and learned alot from the original post and this response. I would feel exactly how you feel neurontin. and Esme12 i found your reply very helpful and similar to what one of my insturctors would say. thanks to both of you!
    Esme12 likes this.
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    The pt may have been a symptomatic at a rate of 130 only temporarily. In afib > 120, the heart loses its "atrial kick" (the small portion of blood ejected from the atria to the ventricles) and thus, cardiac output decreases. I've seen it take a while for pts to become symptomatic (SOB, restless). If it was me, I would have called because of the rate. Live and learn
    turnforthenurseRN likes this.
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    I liked Esme12's response. I would have called. I would have taken the slack from the doc. If he/she wants to write me up, let them. As one previous poster said, 'you can't be sued for calling a doc, but you can for not calling a doc.' When in doubt call.
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    Being new is hard...getting poor advice sucks and dealing with a snarky MD gets old. I am a CVICU nurse and would have called the MD if the afib lasted for any time at or or came and went even if the pt was unsymptomatic. The reason is that there is a significant risk of throwing a clot with these sudden bursts of irregular heart rates. The patient needs rate control, maybe some type of heparin or something similar to decrease the risk of PE/clot and the MD needs to know that it (afib) has happened again so he can make these decisions. Your coworker may have recognized the patient converted quickly and just wanted the MD to know so he could adjust meds in the am. If the pt has afib, gets meds for it, converst to sinus but then returns to intermittent high bursts of afib, even if they come out of it...the MD needs to know... they may decide to add/adjust meds to decrease risk of throwing a clot and better control of the rate. Strokes happen and are awfull!! We are our patients protectors...we know them better than the MDs who round on them for 5min a day...if you are shy about calling at 3am, if you dont want to get yelled at...get over it...you are your patients life line to quality care and they need you ....hang in there...it gets better...:-)
    KayRN1 and altrarosie like this.
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    If you're ever in doubt you should call, I would much rather call than not. Who cares if the MD gets crabby with you...better for you to call than not and potentially end up in a lawsuit.

    Was the patient in sinus then went back to a-fib? Asymptomatic or not, the patient needs rate control...a HR >100 is considered "uncontrolled a-fib." Maybe they needed some diltiazem. Were they on any anticoagulation? If not and there are no contraindications, that is definitely something to call about. Patients with a-fib who are not anticoagulated are at great risk for having a stroke.
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    I feel for you. I am a new grad (8 months) on the DOU/Telemetry floor of a trauma hospital. MOST of our doctors are nice, and I work the day shift, so it's a bit easier to communicate. I once called a doc near the end of my shift to tell the doc that the patient had a 3.5-second sinus pause but was asymptomatic, and did he want to write an order. He said, "Here's an order for you: Don't call me unless the pause is longer than 10 seconds!" His tone was very sarcastic and like he was talking down to me. So, I said, "Okay, doctor. I will write an order not to call you unless there is a greater than 10-second pause, and I will pass this along to the night shift so that they don't bother you with this." He had a pause and then said, "Okay, well...just call me if the pause is greater than 6 seconds." LOL! I have found that when you repeat back what they are saying, they sometimes calm down and rethink it.

    Another example when I was only there for about a month...I called one of the hospitalists b/c some iron studies came back really low. I thought there was reason to be concerned, b/c the pt. was anemic (although not in need of a blood transfusion). The doc said to me, "Are there actually any critical lab values you're calling about?" I could tell she was very annoyed. The next time I saw her, I said, "I know I'm new, and I wanted to thank you for helping me learn when to call you and when not to," She seemed surprised and kinda stuttered and back-pedaled and said she wasn't upset, and thanks for calling.

    I think if we humble ourselves and admit our learning curve or mistakes, sometimes the docs calm down and match it.
    turnforthenurseRN likes this.
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    Good reply!
  8. 0
    Quote from sweetsabo
    I feel for you. I am a new grad (8 months) on the DOU/Telemetry floor of a trauma hospital. MOST of our doctors are nice, and I work the day shift, so it's a bit easier to communicate. I once called a doc near the end of my shift to tell the doc that the patient had a 3.5-second sinus pause but was asymptomatic, and did he want to write an order. He said, "Here's an order for you: Don't call me unless the pause is longer than 10 seconds!" His tone was very sarcastic and like he was talking down to me. So, I said, "Okay, doctor. I will write an order not to call you unless there is a greater than 10-second pause, and I will pass this along to the night shift so that they don't bother you with this." He had a pause and then said, "Okay, well...just call me if the pause is greater than 6 seconds." LOL! I have found that when you repeat back what they are saying, they sometimes calm down and rethink it.

    Another example when I was only there for about a month...I called one of the hospitalists b/c some iron studies came back really low. I thought there was reason to be concerned, b/c the pt. was anemic (although not in need of a blood transfusion). The doc said to me, "Are there actually any critical lab values you're calling about?" I could tell she was very annoyed. The next time I saw her, I said, "I know I'm new, and I wanted to thank you for helping me learn when to call you and when not to," She seemed surprised and kinda stuttered and back-pedaled and said she wasn't upset, and thanks for calling.

    I think if we humble ourselves and admit our learning curve or mistakes, sometimes the docs calm down and match it.
    I love the way you handled those kind of situations. :-)


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