The good feeling when you make the right call

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    I've been an LPN on a med-surg floor with multiple central telemetry patients for almost a year now. I've learned a ton and really like my job. Its surprising how much stuff there is to learn. One thing I learned a few nights ago is just how important those support people are.

    I had a patient in with pancreatitis but was on telemetry due to arrythmias. He typically had several PVC's a minute. In the ED he was having about 20 pvc's/min according to the ED documentation. They didn't seem too worried. He had just been admitted a few hours before I came on shift at 7p. About 2000, the central tele tech called to tell me he was running bigimeny with a couple short runs of v-tach.

    I checked the patient and he seemed fine. Awhile later about 0100 the tele nurse came over and told me that he was in sustained bigemeny and it was slightly concerning. She also said that she had looked at his labs and saw that his Mg was 1.6...the lowest possible normal value. She said that it might be a good idea to get an order for IV Mg replacement. I looked back at his old strips, H & P, and EKG from that night and previous admission. It looked to me that his multiple PVCs were normal and at the time opted not to call the MD. I kept going back and forth in my head what to do. Another person on my floor needed to call the same doctor and I opted to go ahead and let him know and see what his response was. He ordered 2gm Mg IV. About an hour into the 2 hour infusion, the tele tech called and told me that he was now running basically NSR with ocassional PVCs and they were able to get a whole 6 second strip with no PVCs at all.

    Even though I wasn't the one to think about this order, it made me feel really good that I had a part in straightening things out for this pt. It also made me realize that the people in these support positions are there for a reason, because they have a wealth of experience and knowledge and even if they MD doesn't agree with their assessment and suggestions, its probably worth making the call.
  2. 1 Comments so far...

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    if i remember correctly, blood levels of mg are not that accurate......the tissue levels are lower......another example of look at the patient and not just the #'s.....good catch all around


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