New Grad, new job... My First emergency! - page 4

by beatrice1 6,839 Views | 39 Comments

I am a new Grad landed a job in LTC which I LOVE! I have been on the job for 3 months now. I am still learning alot and not too sure of myself. Everyone says "use your nursing judgement" but it's hard when you don't have any... Read More


  1. 0
    IMHO, in AF, if the rate would otherwise be considered "Sinus Tach" or even SVT, I'd call it "RVR" and document the rate. SVT is (to me) is nothing more than a catch-all for any fast, narrow complex heart rate that's >160. In my mind, AF with RVR is more descriptive of why the heart's beating that fast in an irregularly irregular pattern.

    Of course, I'm no authority in the matter...
  2. 0
    I've thought of SVT or PSVT as a regular rhythm, where a-fib is irregular. Also not an authority.

    I guess in the big picture >150 equals "too fast" and "do something to slow it down"
  3. 0
    Rates >150 without a reason to be going that fast is too fast and something should be done to "slow it down" especially if the patient is symptomatic.
  4. 0
    Rapid ventricular rate. Yes, pulses can get that high, and it would be hard to count if it were that high. If it's too high to count, then intervention is needed. Sounds like you did a good job for your first time. You listened to your patient, and followed up. She got the care she needed. Maybe she converted into a-fib, maybe she went into SVT, maybe she was internally bleeding. Who knows? Without a work-up, you can't possibly say what's wrong with her. Kudos to you! It will get easier with time. I am a newer nurse, too, so I empathize. Everything gets easier the more often you handle something.

    What did you learn from this? That you can trust yourself? Yes, it's good to ask for help when you need it, but if you know your patient is in trouble (which HR of 180..yes, you can delegate). Stay with your patient, and ask someone to call to get her sent out. What would I have done? If I was sure she needed to be sent out (like definitely needed acute care) Called EMS and sent her out immediately, then right after calling EMS, I would call the doc to get the order (b/c sometimes there's a delay until they call you back), but you have to do what you are comfortable with (that's what I used to do at the facility I worked at previously), but my first time dealing with something like that, I did exactly what you did. Then, I changed how I responded.
  5. 0
    I agree with the other posters, you did the right thing. You used your assessment skills by immediately taking her vitals. Even though it was difficult to obtain her BP, you were aware that her pulse was dangerously high and warranted a call to the doctor.
    I, too would be nervous about this type of emergency because I'm a new nurse as well. Just remember that you went with your instincts and ended up doing the right thing! We've all been taught to listen to our patients: If they tell you they "don't feel right" pay attention and assess them carefully. That's what you did. Don't be hard on yourself. It is going to take us new nurses time to pick all of this up. (Something I have to remind myself a lot!)
    Good luck with your job and your nursing career!
  6. 0
    As a nurse, I've only seen heart rates that high in newborns

    As a patient though, I have had two episodes of SVT, and both times, my heart was going at about 240. I kid you not. I counted it myself -- carotid pulse, 6 second count multiplied by 10, and yes, it is difficult to count. I was so shocked by the number I was getting that I checked several times.

    Both episodes were preceded by about 5 seconds of extreme dizziness. Only other symptoms were the extremely rapid heart rate, tightness (but not pain) in my chest, and feeling a bit too cold. The first episode resolved on its own in about 5 minutes. I had called the on call doctor at my PMD's office, and by the time they called back, it had stopped. They told me if it happened again I should go to the ER.

    Next time it happened, about 5 months ago, I called 911. Normally I'm an easy stick, but it took the paramedics 4 tries to get an IV in (blood doesn't circulate efficiently when your heart is beating that fast) and two tries at getting the right dose of adenosine (which makes your heart stop for several seconds and was the most indescribably horrible thing I've ever felt in my life) before they got my heart rate back to normal. My heart had been beating a good 30 minutes at that rate -- it was such a relief when they finally got it to go back to normal!


    Lots of things can trigger SVT, but in my case the likely culprit was caffeine -- during my first episode, I had had 5 cups of coffee on an empty stomach!!! These days I limit myself to at most one caffeinated beverage per day, and even that's probably too much (but I can't quite quit entirely).

    Anyway, don't mean to hijack the thread, but since we're on the topic of things that can cause ridiculously high heart rates in adults, thought I'd share my experience.

    OP, I think you did exactly the right thing for your patient, including calling a more experienced nurse to help you deal with the situation. Next time one of your patients has a high heart rate, you'll know it's likely real (though double checking manually is, of course, an excellent idea!). Chalk it up as experience, and give yourself a pat on the back for doing the right thing!
    Last edit by noahsmama on Dec 9, '11
  7. 0
    Quote from Do-over
    Years ago (EMS training) I learned about using vagal manuevers, but were cautioned about trying it with the elderly (because you don't want them to vagal down to cardiac arrest, say). I still kind of think all you'd get with the elderly is a code brown. Just my hunch, however.

    Tried it not too long ago with a younger man in SVT - no dice.
    code brown. the visual of that made me laugh so hard I almost woke up my napping kid. lol EMS/ER probably wouldn't appreciate it either.
  8. 0
    Quote from noahsmama
    As a nurse, I've only seen heart rates that high in newborns

    As a patient though, I have had two episodes of SVT, and both times, my heart was going at about 240. I kid you not. I counted it myself -- carotid pulse, 6 second count multiplied by 10, and yes, it is difficult to count. I was so shocked by the number I was getting that I checked several times.

    Both episodes were preceded by about 5 seconds of extreme dizziness. Only other symptoms were the extremely rapid heart rate, tightness (but not pain) in my chest, and feeling a bit too cold. The first episode resolved on its own in about 5 minutes. I had called the on call doctor at my PMD's office, and by the time they called back, it had stopped. They told me if it happened again I should go to the ER.

    Next time it happened, about 5 months ago, I called 911. Normally I'm an easy stick, but it took the paramedics 4 tries to get an IV in (blood doesn't circulate efficiently when your heart is beating that fast) and two tries at getting the right dose of adenosine (which makes your heart stop for several seconds and was the most indescribably horrible thing I've ever felt in my life) before they got my heart rate back to normal. My heart had been beating a good 30 minutes at that rate -- it was such a relief when they finally got it to go back to normal!


    Lots of things can trigger SVT, but in my case the likely culprit was caffeine -- during my first episode, I had had 5 cups of coffee on an empty stomach!!! These days I limit myself to at most one caffeinated beverage per day, and even that's probably too much (but I can't quite quit entirely).

    Anyway, don't mean to hijack the thread, but since we're on the topic of things that can cause ridiculously high heart rates in adults, thought I'd share my experience.

    OP, I think you did exactly the right thing for your patient, including calling a more experienced nurse to help you deal with the situation. Next time one of your patients has a high heart rate, you'll know it's likely real (though double checking manually is, of course, an excellent idea!). Chalk it up as experience, and give yourself a pat on the back for doing the right thing!
    Adenosine is given 6mg RAPID IV push. If that doesn't work, then you get 12mg RAPID IV push. As you've found out, it's guaranteed to be one of the weirdest feelings in your chest... Caffeine in high amounts can very much cause SVT or even short runs of VT.
  9. 0
    I think you did great great, especially since this was your first emergency. A good reminder to always take our patients seriously when they tell us they "just don't feel right". Great job!
  10. 0
    I consider RVR to be 130 or above...


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