Whoa! Crazy ProTime/INR

  1. Had a total "" moment at work last night.

    I walk onto the floor and we're getting slammed - 5 admits in half hour,
    Ofcourse, all during shift change time

    Had 7 patients all to myself: One very agitated, combative post bowel resection patient in restraints. A 60 year old with CP, mental retardation, MS, seizures (who should be on the neuro specialty floor but wasn't because neuro was full) who was on tele with a Cardizem and Dilantin drip and weird heart rhythms. An ICU transfer. A post perf'd duodenal ulcer with 5 lines going in and 7 lines/tubes coming out. A post hyst who couldn't stop puking all night. My only "normal" patient was a bilat. prophylactic mastectomy...

    ... and last but not least, a "direct admit" - LOL all of 80 years old who tends to be "forgetful" at times. Dx: Fatigue and loss of appetite. Hx: Chronic a-fib, osteoarthritis, carotid artery clot repair.

    All this on a "surgical" floor :selfbonk:

    34 beds. 34 patients. 5 nurses. 1 CNA!



    I literally zombie'd through my shift. Naturally missed lunch and pee breaks. :trout:

    Come morning time - still doing chart checks at 0530. Haven't started charting for the entire night!

    Waiting for AM shift to get out of report. Get called a critical value on my LOL 80 year old:

    PT > 120
    INR > 13.4

    [Yes. It meant "greater than". Values were so far beyond the high range end, lab machines were not caliberated for it!!]

    I thought someone was playing an April Fool's joke a week late.
    Not so!

    Had a total "" moment right there!
    Burned my fingers hitting he MDs pager number on the telephone....
    Sweated bullets till he called back.

    I read him the values and I can almost see him *shrug his shoulders* and he just says "Ok. Thanks!"

    His reaction kinda felt like a let down.

    Found out later patient takes 2.5mg Coumadin for prophalaxis following a-fib diagnosis. Wondering if she'd been popping one pill too many ...

    Oh well. I finally made it home an hour ago.

    Just wondering how common it is to see PT/INR values that high...
    Last edit by Roy Fokker on Apr 6, '07
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  2. 25 Comments

  3. by   TazziRN
    Oh my........... is right!! I have NEVER seen one that high!!
  4. by   gitterbug
    Roy,
    Sounds like you were a little busy that shift. LOL! Please tell me you charted calling these numbers to the doc, the response, and filled an incident report. This is too much to be ignored. Does your lab not call to follow up with the nurse on critical values like this? Just as a nursing precaution was patient put on fall precaution, bleeding precautions, and frequent checks? Man, my mind is boogled. Have a blessed day.
  5. by   jmgrn65
    yes it does happen and I have seen them that HIGH. I have a docs do the same reaction. but then they come in and want to do everything stat.
    Vit k or platlets. but sometimes they don't want it to come down to quickly and put them at greater risk.
  6. by   mustanggirl
    HOLEY SMOKES! God bless you floor nurses because you are so resilient. You need to pat yourself on the back for surviving that shift. These are the kinds of days I try to block out of my memory from when I worked on the floor, but heck they are the ones I remember most.
  7. by   VivaLasViejas
    Quote from mustanggirl
    HOLEY SMOKES! God bless you floor nurses because you are so resilient. You need to pat yourself on the back for surviving that shift. These are the kinds of days I try to block out of my memory from when I worked on the floor, but heck they are the ones I remember most.
    My sentiments exactly. Also, one of the main reasons I got the heck out of med/surg before I found myself on the wrong end of a lawsuit:angryfire
  8. by   blueheaven
    Quote from jmgrn65
    yes it does happen and I have seen them that HIGH. I have a docs do the same reaction. but then they come in and want to do everything stat.
    Vit k or platlets. but sometimes they don't want it to come down to quickly and put them at greater risk.
    That's when I tell 'em to hold their shorts cause they weren't that upset 1-2 hours ago!!!:trout: Or they will call you up and ask something stupid like...Could you get a gas on so and so?? NOT ME! Then I remind em what the INR was. If they still want it...they can get it themselves. I thought FFP was the "drug of choice" for elevated INR.
  9. by   EmerNurse
    The assignment you describe sounds insanely scary and dangerous - just had to mention that.

    The lab values? Had a guy come into the ER with a "risen", you know, an abscess that needed poppin' on his thigh. Ran basic labs since he'd prolly need an I&D and was on coumadin. His PT/INR was THROUGH THE ROOF - higher than those you listed. And he was in the waiting room. LOL. Zip - straight from a "risen on the thigh" to "ICU here we go"!

    Yeah, it happens, and always when ya least expect it.
  10. by   jmgrn65
    Quote from blueheaven
    that's when i tell 'em to hold their shorts cause they weren't that upset 1-2 hours ago!!!:trout: or they will call you up and ask something stupid like...could you get a gas on so and so?? not me! then i remind em what the inr was. if they still want it...they can get it themselves. i thought ffp was the "drug of choice" for elevated inr.

    uummm it is i had a brain fart:uhoh21:
  11. by   BrnEyedGirl
    agree w/the others,..this is exactly why I left the floor!!! Sorry about your horrible night!! I have seen INR's that high,.probably for just the reason you said,..did you see earlier labs?,.maybe INR was 22 and is actually on the way down so Doc didn't get real excited? (giving him the benifit of the doubt ) just a thought,...hope your next shift is better!!!!
  12. by   TheCommuter
    The highest PT level I've ever seen is 71.
  13. by   burn out
    I know they can get high but it has been awhile since I've seen one that high. I think one area that effects the patient on coumadin that we forget and lack greatly at is educating them on their diet...one good green spinach
    salad may push it up high. I remember when my dad was on coumadin therapy when they finally got his pt/inr regulated he ate the same thing day after day so he wouldn't mess it up.
  14. by   clou
    I had an admit a while ago, male in his 50's. He was W/C bound, fell out of his W/C on a steak knife that stabbed him in the chest. He received a stab wound below his right nipple. He didn't come to the floor until approx 48hrs later because the stab wound wouldn't quit "oozing" he said. He admitted to the floor with the dx of hypercoagulation. INR 17.6 --- Dr only gave him 10mg SQ vitamin K!!!!!!!!!!

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