Had a new admit the other nite. BP 130's/50's. HR 50's. Was there for about 2 hours when she started pausing. 6 or so pauses in 10 minutes. 2.3sec average. Longest was 3.36. "Asymptomatic" I say that because she was admitted with weakness/syncopal episodes...SO when I speak to her she says she feels "the same". Alert, BP 160's/70's. She takes cardizem 120mg SR. Called resource nurse who says she's ok. bp steady,asymptomatic. Call DR. and update. Doc says hold cardizem, EKG in am.
She steadied out for about 2 hours then had 11- 2.60 pauses in a 10 minute time span. NOW, I am nervous---I was with the earlier scenerio, too. BUT resource nurse made it seem like it was no big deal(Oh, yeah NA 123). SO, when she starts this, I ask the other 2 nurses what they think. Should we at least put the cart outside her room?? They rolled thier eyes and side with the resource nurse saying that she is asymptomatic and what is he going to do tonite anyways?? She does recover quickly from the pause--right back into SR same rate as before the pause. I SAY--too many pauses. YES she is symptomatic at some point if she is having syncopal episodes and her BP is increasing 190/70. I say this is her body trying to compensate. Now this is a new larger facility for me and these girls have been there longer/seen more. BUT I still am uncomfortable-so I called the doc and he shipped her to CCU. What are your thoughts on this?
Oct 22, '07
Were you by chance showing your nervousness around the patient? That could account for the increase in BP. Those pauses aren't too long, but if they were increasing in frequency , I would have called the doc to come assess the strips and probably send her elsewhere for closer monitoring. Was she a sick sinus syndrome patient, or in some kind of block from the Cardizem?? True enough her BP was holding and she was obviously alert enough from what you said in post, but if the pauses were getting longer and more frequent then I would also had her assessed and possibly shipped elsewhere. Not my favorite thing to have to pace a person with the pads at the last minute. Were they considering a permanent pacer or just going to watch her rhythm a few days off the drugs? I would hope she also had a big fat line in somewhere. Always better to go with your gut, you did the right thing for your patient.
Oct 22, '07
Thanks for the reply. No, I don't believe I was showing my nervousness around the pt. Recently switched jobs from a rural hospital. We called any pause over 2 sec's. I am still trying to get the feel for this larger one (hit the floor in June). What is considered a "long pause"? 3 for me...but maybe that is the "small town" hospital in me???