Such a 'tool'

[Antikigirl, ASN, RN]

So, I had this patient that just got back from angioplasty and she was doing excellent! She was talking and just her normal self. I left the room after all those checks on her every 15 minutes in confidence that she was going to be going home that next day.

Oh yeah, isn't that when things go wrong? LOL!

There is a few threads I could do on this one incident alone, but lets go with the old SaO2 monitor part!

My patient started gasping for breath...her accessory muscles going full force and her chest could barely rise and fall. She started getting the dusky tint to her lips and nails...and she was struggling hard. I quickly jumped on it, bumped up her O2 on her Nasal cannula, and called for a rapid response (this is a pre-code call...this alerts folks that if things don't happen fast we will have the full out code!).

Well...long story short, I did wind up switching to a non-rebreather even though her SaO2 said 92% on 5 L/Min and bumped it up. WHY? Because even though the SaO2 monitor said that...my patient was turning BLUE! An RT rushed in and bumped it up to 15 L/min...and we proceeded throughout this incident to have to give her lots of antiarrhythmics for SVT, and cardioversion X 3...almost had to intubate, and it bought her 5 days in the PCU!

However, I was totally reemed for increasing the oxygen when someone has a SaO2 of 92%! Okay...what ever happened to watching your patient!!!! No, they cared more about the numbers than my patient!!!! My patients tidal volume was nill...we needed every scrap of oxygen atoms I could give...and I knew this from common sense and looking at my patient!!!!

Needless to say, management still says I overreacted...MD's and RT's and others that actually remember a day without SaO2 monitors know better and are in full agreement with my intervention!

How about you guys....have you ever had to battle a machine that is to be used as a dx tool vs actually going by the reaction of your patient regardless of what that tool says??? Have you gotten into hot water over it, and had to justify yourself over a machine???

This is a huge pet peeve of mine, and if I had my dithers, I would have all manual back again till some people realize a tool isn't the end all to patient care~!

[Balder_LPN, LPN]

My patient started gasping for breath...her accessory muscles going full force and her chest could barely rise and fall. She started getting the dusky tint to her lips and nails...and she was struggling hard....my patient was turning BLUE!

have you ever had to battle a machine that is to be used as a dx tool vs actually going by the reaction of your patient regardless of what that tool says

...till some people realize a tool isn't the end all to patient care~!

I go with how I learned it in school (i'm still a new grad btw). a tool is a tool and should be used, but no tool can override your assessment of a pt.

[AngelfireRN, MSN, RN, APRN]

I have always been of the opinion, "Treat the patient, not the monitor". Kudos to you. You saved her life!

[jessiern, BSN, RN]

Tele monitor continously showed my patient with a pulse of 180-220. I was continuously telling people that his t wave was so elevated that the monitor was double counting his HR. Even had one doc and nurse run in with a crash cart while I was assisiting patient with bath.

[Antikigirl, ASN, RN]

LOL...had that one too Jessie! Had some peaked T-waves that were signaling a pulse....and I pointed this out several times...I found out the next shift they called a rapid responce (call under a code in our facility) all to have a very upset MD woken up for spikey T's...found out...you turn the gain down a bit...we didn't have the probelm...sheesh! (I had turned the gain down, and someone put it back up to read it better...uhggggggg!!!!)

Thank you so much Anglefire!!!!!!! Yep, I was confident I did the right thing...and I was labled a rougue! LOL!!!!!

Balder...keep that up! It will be right every time! I learned it that way not in school, but through talking to RT's ER MD's and paramedics while in school! Glad they told me that!!!!!!

[Pediatric4077]

You were totally in the right. You assessed the patient.. machine was faulty. I've had pulse Ox's say all kinds of non sense... like others have said here you use tools but your assessment is what is key.

I've had pulse Ox's read 100% and not be on the patient. They are faulty. Great tool, but not a nurse!!

[Peepsaretasty]

I could swear I read somewhere that at 90% reading on the SaO2 that the oxygen carrying capacity or something similar is actually only at 60% and drops exponentially after that (as in 80s even worse etc)

Anytime I see anything under 95 it makes me think twice. I think I'd have done the same as you did. I mean, OBVIOUSLY if the patient is BLUE there is something wrong! hello, This is Earth calling management, over?

[aeauooo]

I was totally reemed for increasing the oxygen when someone has a SaO2 of 92%!

Reemed by whom? - and why the heck should you care about the opinion of someone who doesn't know what she/he is talking about?

If I had a nickle...

[LadyTiger44]

I am also a new grad, and I have not started working yet ( I do on the 27th!) but I was always taught to go by your assessment and not the monitors-- so you did the right thing! How could you get in trouble by someone who was not even there??

[Agnus]

Ask the person who reemed you what they would do with a blue pt struggling to get a breath. Really anyone with half a brain will tell you oxygen saturation monitors are not infallible.

Additionally you can have 100 percent saturation in a number of situations and the patient will be hypoxic. Such as a low hemoglobin. another is the presence of carbon monoxide.

Who is this idiot?

[Ayvah, RN]

What in the world..

I have also been taught that anything under 94% requires a second look at the patient, just as a heart rate under 60 would require a second look at the patient. They may be fine, but the assessment of their status trumps all monitor readings.

If my patient is going bad but at 98% O2, I would still apply readily accessible O2 as an immediate intervention if a respiratory or cardiac problem is suspected; it can only help.

And especially since RT bumped it up even more after coming in - that's even more justification to increasing the O2.

I don't understand the fuss over increasing the O2... Not like it cost the hospital thousands of dollars for you to bump it up. Its par to flipping out over taking the patient's temperature at an unscheduled time. It doesn't make any sense. I don't see the negatives that they apparently do.

[Dolce, RN]

Good for you!! We had a patient go into respiratory arrest under the care of a new grad once. She was carefully studying the monitor while the patient turned blue in front of her. Always treat the patient, not the monitor.