New Grad, new job... My First emergency!

  1. 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 experience.

    Last night I had a resident who came to me to say she "just didn't feel right" She said she was dizzy and her head hurt. I took her vital signs... pulse was 180! I thought something was wrong with the pulseox, I have never heard of a pulse getting that high. I tried to take her b/p. could not hear anything, tried both arms. couldn't get it. I called another nurse in (the LPN that was passing meds) I asked her to try. she couldn't either. I immediately called her doctor and reported it and he said to send her out to the ER. Did all the necessary paperwork while the other nurse sat with her.

    This was the first time I had an emergency, first time I even had to call the doctor first time filling out all the paperwork...ect. I was so overwhelmed, I feel like all my assessment skills went out the window.

    Could someone give me feedback as to what more I could have/ or should have done. I would appreciate it.
    and has anyone ever seen a pulse rate this high?
    (she has history of A-fib and MV repair)

  2. 39 Comments

  3. by   Coulter630
    I've seen many pulses this high. ICU is a great place to see that kind of stuff. I'm confused as to what you are saying is a pulse ox. Usually when I use that term I'm thinking about how much oxygen is getting to the tissues (capillary). You said, I've never seen a pulse ox that high. They are supposed to be high 94-100%, is considered good in any hospital I've ever been.
  4. by   FancypantsRN
    Was probably Afib with RVR, it happens quite a bit - and her dizziness would be accounted for with how fast her heart was beating. You definitely did the right thing in calling the doc and getting her to the ER. You learned from this experience and will continue to learn with others in the future (where the nursing judgement will come from) -I say good job!
  5. by   jmdRN
    180 is not unheard of in a-fib. I've seen a-fibs in the ER running 220, tho not for long. You did well to send her out, likely they'll medicate her to try to convert her back to NSR or at least slow her HR to the low 100 range.
  6. by   CoffeeRTC
    Um...sounds like what you did was correct! If you had any "crash cart" like items you could have gotten them ready while waiting for EMS. (our EMS response time is around 2-5 minutes) If EMS gets there before the paperwork is done, just get them out of the facility. You can always fax the papers to the ER.

    Good job!
  7. by   CoffeeRTC
    Oh...I bet you were using the pulse ox to get a sat and pulse?
    Always check manually. In LTC alot of folks have poor ciruculation and the pulse ox machines don't work right.
  8. by   brownbook
    You did fine. However, did you put her on oxygen while you were waiting?
  9. by   nyemt2005
    sounds like a basic ACLS scenario.
  10. by   beatrice1
    I did mean the pulse oximeter reading was 180. I did try to get her pulse manually but I was so nervous and her pulse was running so high I had a hard time counting.
    I did put her on o2 while waiting for ER to come.
  11. by   beatrice1
    what is RVR?
  12. by   DixieRedHead
    Quote from beatrice1
    what is RVR?
    Rapid Ventricular Rate
  13. by   CapeCodMermaid
    You say your assessment skills went out the window, but you DID assess the woman. You found her vital signs to be out of the normal range and acted appropriately by calling the doctor and sending her out.
  14. by   evolvingrn
    Usually when someone is in a fib you can't get it on a pulse ox machine... you get a normal pulse and then when you put your stethoscope on their chest you get the high one.