Had a wierd night, but good story about trusting your gut!!!!
After 6 hours of one on one sitting (had no cna's) I had to change and take on a lady who was in the ER and complained of abdominal pain who was discharged but the husband threw a screaming fit so they admitted her. My report...we can't find anything wrong with her...doubt there is, proably another psych case.
When I met the couple, the older man was very sweet and poliet..this didn't match the description at all, and the wife...very sedate and sleeping hard. I heard she got some pain meds and was sleeping them off. Okay... So on with my assessment, but something FELT wrong in my gut! Only exceptions in the assessment were a distended abdomen but hard to tell from her obese nature, and was a little pale in the face. But for some reason I was far from comfortable with her sedation level...even though it was just my gut talking!
Then about 10 minutes later I walk by the room and she her legs were shaking every time she had a large snore. Okay proably undx sleep apnea, but I chose to do another set of vitals and check her CBG...something just wasn't right in this sleeping lady! (husband had left).
Just then the hospitalist (MD) came in and was reviewing her charts and I told her what I saw, and what I was going to do. She agreed. I went in and she had a CBG of near 200, and couldn't get a BP because the largest cuff I had couldn't get it...I was about to get my manual when I noted her speech was slurring for a moment...did quick crainal nerve checks..they were fine...but this didn't seem right!!! Not right at all!!
The MD rushed into the room then and I told her what I had seen, I also told her the patient says that this has been her typical migraines for a few months, fast and hard, and she takes a methadone to help. The MD didn't seem to think that was important info like I did (recent history of migraines of serious magnitude...this woman could blow!) and she said "lets not downplay this" Downplay this? This is assessment data you dork! (she is a newer MD and emergencies are NOT her favorite...)
Then she said Nitro patch 0.4 stat, I want some vasotec in her stat, stat EKG and lets get her rolling to the ICU. Seems that the ER forgot to mention they were getting bps on her of 210/106 and the MD caught that hidden in paperwork on the chart...they told us her bp was 153/90 and it was written that way on admit paperwork????!!!!!!! Ummmm you don't send someone to the med surge ortho floor with that kind of bp and you certainly better darn well make sure you have the facts straight...there was no way it was that low!!!!
I couldn't get a BP on her at all...off the charts, and the lady woke and jumped out of bed...I mean litterally! Ran to the BR, threw up, and three of us nurses got her back in bed and her head was 10/10 pain and panic set in. She couldn't sit still...hot/cold sweats...and was in serious head pain! EKG showed tachy but nothing else. She declined oxygen even though I insisted...I hadn't worked with vasotec before, so I just get this vial thrown at me and I was like "okay and my dose is??? I assume this is IV push? Push fast or slow?" (the doc must have thought I was an idiot...but I wasnt' going to give it wrong!). Okay dose was half the vial (1/2 ml = 0.625), and we just got her IV in....push...saline...she jerked and ripped the line out...but it was in! WHEW!
Then they rushed her to the ICU. Triple A in progress or stroke is the fear...and I hope that I was able to trust my gut soon enough to help her! I have prayed for her all night!
Okay...I am not an ER nurse, and typically I can handle situations calmly which I did actually....but wow, did the ER drop a bomb on me there! I know you can't see triple A's, and they can be insidious...but that bp...wouldn't even a tele floor be more appropriate if not the ICU? Strokes I have seen...too many too...and well, maybe that was my gut feeling...but in a sleeping person? WOW!
Sometimes, even if you don't know why your hackles are up, or you gut is saying "something isn't right" good thing to trust it! Glad I did, and hope to GOD I was quick enough!
Nov 8, '06
THREE CHEERS FOR TRIAGE
i hope that when i come to hospital you or your twin is on duty
Nov 8, '06
THanks hon! I just hope I got her in on time to save her. The ER pushed her off as a drug user and just seeking....ummmmmm NO! Lucky for me I don't trust the term "drug seeker" but actually try to find an underlying probelm in pts. I am just shocked that my gut was actually twisting on me that something was very wrong with no outward signs at all to get my red flags a flying....but thank GOD I listened to my gut!
Nov 8, '06
first great work .and following your gut may not be scientific but it works .the er sounds like it missed the boat hx migraines b/p 200's she should have had b/p meds and head ct .
Nov 8, '06
Great catch Triage! Awesome job!
Nov 8, '06
NO kidding..they actually had her come in by ambulance, then discharged her, then she came back under the paniced insistance of her husband that something was very wrong! He too felt something was up, but didn't know what but knew it was seirous...and I got that vibe right away from the pt, then through him...he wasn't angry, he was boldly concerned and was not going to let this go!
If that gets labled as a drug seeker in their book...I will surely be in trouble if I have to go there for a loved one or myself! I will insist on things or complain to the top!
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