ICU experiences: how do you know when to worry...

You have to take everything into account, usually all at once. You definitely get better at it over time. Past history, current illness, today's chest XRay, recent blood gas, what the patient tells you etc all tell you whether to worry. Plus, there is a definite gut feeling about when things are getting ugly.

I am going to be a new grad RN in the ICU and I worry about the same thing!

What is the respiratory rate? Are they over loaded? Do they need lasix? Do they have COPD? If they have COPD you could knock out their respiratory drive with a NRB. Being a new grad in the ICU you need to ask questions, the ones who don't are the ones who get into trouble. Ask your respiratory therapist for suggestions, they may know the patient from previous hospitilizations, and should be aware of the problem if the patient is already on HiFlow.

My suggestion is to find yourself a few reliable/knowledgable resources on your unit and develop a relationship with them. It takes a long time to be comfortable in the ICU as a RN, but keep at it and it will be rewarding.

I am a new nurse too and I always worry. If I am unsure about something eg. the changing status of a patient and actions to take, I feel the need to ask another nurse, sometimes even before I call the MD. And if I don't feel convinced with one answer, I will ask another nurse for more opinions and rational. I just feel safer that way.

Does your unit have its own dedicated critical care RT. When I was a new grad, I ran any respiratory concern past our RT... whoever was on was very patient about explaining why or why not they were concerned.... loved being asked questions and having the opportunity to educate new blood.

Also, grab a nurse or two and talk it over... On our unit, anytime we have a problem or question, we talk it out together, 2 or 3 minds are way better than one.. you learn so much that way.

First, with the SpO2 remember it is giving you insight into only one component of the respiratory status: Inferred PaO2. Basically the pulse ox will give you a (usually) very good indication of what the PaO2 is. The rest of the compenents are: PaCO2, pH, Bicarb (blood gases), what the lung sounds are (indicating fluid, bronchoconstrictions, etc), what the chest x-ray looks like, what the baseline is and a few other things.

The short answer to your question of "should I worry about a sat of 83%?" is: sometimes yes, sometimes no. I know, crappy answer! Everything else being equal, I am mildly concerned about a sat in the low 80s. I am much more concerned when that sat is on high flow O2. I am very worried if my patient that was in the upper 90's is in distress and now in the low 80's. See how you have to kind of put the picture together? Don't worry, it comes with time.

How do you know what to do? Ask questions. Lots of them. Learn who gives you answers that make sense (some people are morons and try to pretend they know what they doing....they are VERY dangerous). Ask "why are we not treating this spo2 of 83%, but we are treating patient X differently?". Resp techs are great resources, the ones that migrate to ICU are usually at the top of their game.

Lastly, ALWAYS treat the patient not the monitor (applies to pulse ox as well). The disposable probes we use are notorious for all of a sudden reading 70% with a great waveform for a minute or two then popping right back up to 99%. I walk in the room, patient is warm pink and dry in no distress. I treat my patient, not what the little number shows...

ALWAYS treat the patient not the monitor , that is the best advice here. Good luck!