This week took care at shift chage of a patient that going to monitoring medical unit.
I didn,t really had time to take care of her since she was going up
but I have a few questions:
60-70 yrs old lady with big cardiac hx( mitral regurgitation, LV
,crf with usual cr around 120 level 2. Come with SOB. Under medecine.
ABG P/F: 180, ph normal but on the low side, co2 slightly elevated ,
normal lactate and a po2 of only 72 with 40 % o2( labs from 0102 took patient at 1100). Not really in distress but sob with 2-3 words
sentence and tachypneic at 28. U/O of only 10-13 cc/h.with low 90 bp.
On report RN state rounds was done and all medecine was inform of her
Here my questions:
1)wasn't she to unstable to go on the floor??
2)with such sign of shock shoudn't have receive more then the mininal
bolus she was receiving??( 250-500 x 2-3time with a NS at 50cc/h)??
3)Would a bipap would have been good in that condition, even if the
gas was normal at this time or it would have made her BP worse r/t intrathoracic pressure?
4)would our patient benefits from some physio therapy ( chest
percussion) like the ICU does??
Apr 7, '07
I would not have sent her to the floor unless she was a no code.
Do you want to bolus a pt who is in CHF with CRF?
Bipap...I have no idea, do not have any experience with it.
Pulmonary toilet....no idea.
Apr 8, '07
Where I work this pt. would probably have been placed on BiPAP & gone to the unit, even if only for 8 hours or so, until she hopefully improved enough to go to a monitored floor bed.
Apr 10, '07
She would have been a unit admission at my facility, unless she was a DNR.
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