Hi PICU nurses! I'm coming up an a year in the PICU, and just beginning to trust my intuition in regards to when I think there is a problem with a patient. Have you ever gotten that feeling in your gut that something is up? Even if there is no assessment changes or vital sign changes to indicate it yet? I used to feel that way a lot when I was new, but I think it was more nerves that anything. Now that I'm more comfortable, I'm starting to get some internal feelings that are more accurate.
Recently I had a patient with sickle cell admitted in acute chest syndrome. Something was telling me that she just didn't look right, even though clinically she was okay on the nasal cannula. I kept pushing for another blood gas, increased O2, and another chest x-ray, even though there wasn't any real clinical signs to indicate that they were necessary. It was only when the patient started having some retractions and nasal flaring that we got the gas (bad) and the x-ray (almost a total white out) and put the patient on BiPAP. She ended up intubated and needed an exchange transfusion by the end of the night.
So I'm curious- what stories do you have about your own nursing intuition? What situations did you feel that something was off and were you able to avert a crisis because of it? Please share!