NOC shift, as an RT. A quiet rehab hospital with no docs. The RN calls me to a patient room to observe and ask me what I think...........after I get up off the floor from the shock of actually being asked my opinnion.............I went to observe the patient, and although things seemed to be in order, "something" was not right about it. He seemed to be sleeping soundly, it was just that he never did sleep THAT well.
Protocol indicated ABG's per rt P pulse ox spot check(I forget the exact perameters, it was ten years ago)...anyhooo, the RN asked me to proceed since she wanted to make sure before calling the doc. It was actually up to me
......I wrote the protocol order for ABG's ,drew it, ran it through the analyzer, and interpreted the results(like I said t was a small rehab hos). I determined from the results that the doc did indeed have to be called, and the pt was likely to require intubation
.....The doc was as noncompliant to commands as the pt, and would not answer his pager(imagine that
), so guess who needed to intubate him
.....It was a bit more difficult than it had been on Resusiannie in ACLS class(thank God for that training), but I had successfuly done all the things the doc would have done before he got there. All these procedures were called for, and my actions were protected, and certainly called for, under protocol. The patient would not have survived without my intervention.
The doc, of course, changed all my initial vent settings, and scolded me that the tube was placed incorrectly(I had bilateral breath sounds, and blood gases to verify his ventillation, his pressures were not remarkable) I got scolded by everyone.....except for the RN that never showed her approval in front of others for fear of political incorrectness
..............I knew that my actions were on the very outside of my authority, and knew that because of that, any mistakes would be magnified many fold, but I also know, in my heart, if not for my actions the patient would have died..............So yea, it was a "save". It was also the defining reason I quit RT ironically enough. I guess it could be defined as bittersweet at best.
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What has been your best catch or save!
Picture it--- Night shift, Cardiac step-down unit. 50 yearold post cath 3VD including left main. C/o severe crushing chest pain. nitro gtt as high up as we could go 10 mg mso4 iv over 10 min time frame. EKG changes in anterior leads. (CCU nurse said not MI) Called physician (cardiologist--got earful on word of CCU nurse) Called again 5 min later when reached second nitro plateau---Not relieved. Called back up cardiologist, Prepped for stat cath---closing left main---to or. Appology from first cardiologist--CCU nurse---gone. I was six months out of school. LEARNED REAL QUICK!!!!!!!
