Dad's trip to ED

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Specializes in Public Health, TB.

My little 84 yo father went to our ED the other day with a near syncopal epsiode with a pulse of 32 at home, getting up to the 40s in the ED. He sat there for 6 hours, in that time got a saline lock placed, labs drawn, and EKG and a chest XR. No fluids po or IV were given, his pulse remained in the 40s and SBP in the 110's. He got to my unit at 2330 cold, hungry, and weak. I asked his nurse(one of my co-workers) about what the plan was--who was admitting, diagnosis, food or fluids. He had limited transition orders including clear liquids til 1 am then NPO, routine vs, cardiac enzymes q6h x3. I pointed out that he had not voided in at least 7 hours, and hadn't eaten in 12. She called the on-call doc who relented to let dad have food until 1 am, then NPO and some gentle IV hydration. He still did not void for another 5 hours.

Is this normal to restrict fluids on an elderly person who becomes syncopal on a hot day?:confused: He was told he was going to be admitted after 2 hours in ED,but didn't leave for another 4 hours(at shift change).:banghead:I was with him for this last 4 hours--a nurse came by twice. He was left on a stretcher with the rails up, no call light in reach and was never offered the use of a toilet. :madface:If I treated a floor patient like that I would be severely reprimanded. I never spoke with the ED doc--he apparently spoke to Dad after I left ED to meet him at his inpt room. Normally I see pt's come to the the floor accompanied by family but the transporter made a point of telling me to go on ahead. Hmmm, was the doc avoiding me?

PS Dad's doing much better, getting a pacmaker tomorrow.:)

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I too had a similar episode happen to my late husband in the ER. I pointed out several times he was NPO for now 24 hrs, had a hep lock and was 7 days post op open heart to no avail. He was allowed a regular diet, but was not given meal trays as he was an admit to the ER as no hospital beds were available. I asked for a water pitcher but was told "This is the ER!" yet he was there for over 24 hrs. I had to go to the cafeteria to buy him lunch! He had to climb off the end of the gurney twice to ask for another O2 bottle as he was left in the hallway with no call button. I know it was the ER but basic nursing care still needs to be provided. He ultimently died of a medical incident at age 47....

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Specializes in telemetry, med-surg and hospice.

OK call me crazy but if you are a nurse and watching this go down, well certainly you can be proactive in getting this situation under control. I would have addressed the primary nurse and if that didn't work I would have asked for the charge nurse. Chain of command can be a useful way to go.

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Specializes in Nephrology, Cardiology, ER, ICU.

This sounds very serious and I think I would be taking this up with management as both a pt advocate as well as a family member.

Take care.

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Specializes in ER.

It sounds like the nurses weren't picking up on some important care items, but did you question them, demand food or fluids, get an extra blanket?

I think there may be more to this story.

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Specializes in ER, Infusion therapy, Oncology.
My little 84 yo father went to our ED the other day with a near syncopal epsiode with a pulse of 32 at home, getting up to the 40s in the ED. He sat there for 6 hours, in that time got a saline lock placed, labs drawn, and EKG and a chest XR. No fluids po or IV were given, his pulse remained in the 40s and SBP in the 110's. He got to my unit at 2330 cold, hungry, and weak. I asked his nurse(one of my co-workers) about what the plan was--who was admitting, diagnosis, food or fluids. He had limited transition orders including clear liquids til 1 am then NPO, routine vs, cardiac enzymes q6h x3. I pointed out that he had not voided in at least 7 hours, and hadn't eaten in 12. She called the on-call doc who relented to let dad have food until 1 am, then NPO and some gentle IV hydration. He still did not void for another 5 hours.

Is this normal to restrict fluids on an elderly person who becomes syncopal on a hot day?:confused: He was told he was going to be admitted after 2 hours in ED,but didn't leave for another 4 hours(at shift change).:banghead:I was with him for this last 4 hours--a nurse came by twice. He was left on a stretcher with the rails up, no call light in reach and was never offered the use of a toilet. :madface:If I treated a floor patient like that I would be severely reprimanded. I never spoke with the ED doc--he apparently spoke to Dad after I left ED to meet him at his inpt room. Normally I see pt's come to the the floor accompanied by family but the transporter made a point of telling me to go on ahead. Hmmm, was the doc avoiding me?

PS Dad's doing much better, getting a pacmaker tomorrow.:)

From the information given, I would think the syncopal episode was related to a HR in the 30's and not dehydration. As you stated his SBP was 110. He may have been kept NPO in the ER because they were not sure when he was going to have the pacemaker placed. If there were no beds available in the hospital then the ER can not be held responsible if he had to be there for 6 hours. Sadly this is a relatively short period of time to be in the ER waiting for admission. My patients are in our clinic sometimes for hours and some of them void constantly and there are some that can sit all day and never go to the bathroom. I would think your fathers labs would have been a better indicator of his need for hydration. If the nurses in the ER knew you were a nurse at the hospital they probably thought if your father or you required anything you would ask. If you had questions for the doctor why didn't you ask?

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Specializes in ER/EHR Trainer.
My little 84 yo father went to our ED the other day with a near syncopal epsiode with a pulse of 32 at home, getting up to the 40s in the ED. He sat there for 6 hours, in that time got a saline lock placed, labs drawn, and EKG and a chest XR. No fluids po or IV were given, his pulse remained in the 40s and SBP in the 110's. He got to my unit at 2330 cold, hungry, and weak. I asked his nurse(one of my co-workers) about what the plan was--who was admitting, diagnosis, food or fluids. He had limited transition orders including clear liquids til 1 am then NPO, routine vs, cardiac enzymes q6h x3. I pointed out that he had not voided in at least 7 hours, and hadn't eaten in 12. She called the on-call doc who relented to let dad have food until 1 am, then NPO and some gentle IV hydration. He still did not void for another 5 hours.

Is this normal to restrict fluids on an elderly person who becomes syncopal on a hot day?:confused: He was told he was going to be admitted after 2 hours in ED,but didn't leave for another 4 hours(at shift change).:banghead:I was with him for this last 4 hours--a nurse came by twice. He was left on a stretcher with the rails up, no call light in reach and was never offered the use of a toilet. :madface:If I treated a floor patient like that I would be severely reprimanded. I never spoke with the ED doc--he apparently spoke to Dad after I left ED to meet him at his inpt room. Normally I see pt's come to the the floor accompanied by family but the transporter made a point of telling me to go on ahead. Hmmm, was the doc avoiding me?

PS Dad's doing much better, getting a pacmaker tomorrow.:)

I am not sure if they withheld fluids due to his heart rate, and rhythm...was he blocked? Obviously he required pacing, perhaps they didn't want to overload his vascular system. It may have been too much if they'd increased his blood volume..just an idea.

Hope he's okay now:heartbeat

Maisy

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Specializes in ER/EHR Trainer.
I too had a similar episode happen to my late husband in the ER. I pointed out several times he was NPO for now 24 hrs, had a hep lock and was 7 days post op open heart to no avail. He was allowed a regular diet, but was not given meal trays as he was an admit to the ER as no hospital beds were available. I asked for a water pitcher but was told "This is the ER!" yet he was there for over 24 hrs. I had to go to the cafeteria to buy him lunch! He had to climb off the end of the gurney twice to ask for another O2 bottle as he was left in the hallway with no call button. I know it was the ER but basic nursing care still needs to be provided. He ultimently died of a medical incident at age 47....

I would've sent this to your hospital administration...even though I work ER, meals are orders like any other and can be delivered anywhere....the problem we have is that water jugs, and other things like bed baths do not happen in the ER. We clean incontinent patients, but not a head to toe cleaning....we don't have CNAs and truthfully no time to do basic care. Remember ER nurses are getting the whole unknown package each time the ambulance roles to the door. All the niceties are bonus if received in the ER, not the standard.

Not necessarily our choice, but necessity.

Maisy

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I too had a similar episode happen to my late husband in the ER. I pointed out several times he was NPO for now 24 hrs, had a hep lock and was 7 days post op open heart to no avail. He was allowed a regular diet, but was not given meal trays as he was an admit to the ER as no hospital beds were available. I asked for a water pitcher but was told "This is the ER!" yet he was there for over 24 hrs. I had to go to the cafeteria to buy him lunch! He had to climb off the end of the gurney twice to ask for another O2 bottle as he was left in the hallway with no call button. I know it was the ER but basic nursing care still needs to be provided. He ultimently died of a medical incident at age 47....

I had to leave my husband at the ER overnite as I had our 2 children with us and we lived over an hr away. I did access the chain of command and after 24 hrs got the care he needed. But the staff was infuriated with me....and when his condition later deteriorated they ignored him again when I was gone, resulting in his death. But now I stay at home with the kids due to the settlement I received....

Basic care needs to be provided in all areas of nursing, esp. if pt. are admitted to the ER as no beds are available. There is no excuse, no matter the area of care, for poor pt. care. This happens more often than you think in the ER.

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Specializes in Cardiac Telemetry, ED.

I agree, it sounds like he had symptomatic bradycardia, not dehydration. Is he capable of expressing his need to toilet?

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Specializes in ER/EHR Trainer.
I had to leave my husband at the ER overnite as I had our 2 children with us and we lived over an hr away. I did access the chain of command and after 24 hrs got the care he needed. But the staff was infuriated with me....and when his condition later deteriorated they ignored him again when I was gone, resulting in his death. But now I stay at home with the kids due to the settlement I received....

Basic care needs to be provided in all areas of nursing, esp. if pt. are admitted to the ER as no beds are available. There is no excuse, no matter the area of care, for poor pt. care. This happens more often than you think in the ER.

I am so sorry you had this experience, my heart goes out to you and your children.

I don't consider monitoring a sick patient as basic, but necessary....there are no words to express my sorrow for you at having this occur. We recently lost a family member to poor hospital care-all centered around failure to rescue-it wasn't just the nursing staff but all who were responsible for care! Anyone could've intervened but didn't. It appears that is exactly what happened to your husband. It should never happened in an ER-especially with a physician only steps away!

Again, my condolences...

Maisy

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Sounds like you were at the ER of the hospital I work for. Every time I get a patient up to the floor they have sat down there for 8-10 hours with no food, no water, the incontinent ones are left in their mess, etc. It's really disgusting.

Worse, we've actually had nurses from our floor go to the ER with chest pain and never even get hooked up to a cardiac monitor. One nurse ended up getting a stent.

I know many of the nurses down there and know they are competent. I can only assume the area is so chaotic and out of control that no one knows what anyone else is doing. I can only lay that at the feet of the manager.

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