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Discussion

Emergencies in the home

I was wondering what kinds of emergencies have you seen in the field.

I am considering switching to a PDN in pediatrics from NICU, but my hesitancy lies that I won't have a team of staff in the room. Are the patients YOU have cared for stable and chronic? Or have you taken cases that made you nervous?

Thank you so much for any advice. Much appreciated!

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    My son has made many inexperienced and a few experienced nurses very nervous. He is relatively unstable and can have 30 or more desats in a day.

    Emergencies that he has experienced are severe respiratory distress (he is on a vent 24/7 but was gasping for air at 10lpm), prolonged seizures that caused him to be dark blue from head to toe, extreme bradycardia, accidental decannulations, difficult trach changes, severe desats (less than 50%).

    That being said, if you are a nurse with great clinical skills, great emergency response skills and great thinking skills, you should be fine. The most important thing (to me and my son) is that you recognize the beginning of a situation and respond immediately and know when to call 911.

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    I have been in home health off and on for years. I am also a foster parent for a medically fragile child (respite only currently) and has seen many scary incidents both working and as a fp. At the end, as long as you have good assessment skills, excellent patient-specific training, and as ventmommy so wonderfully put it, know WHEN to call 911 you'll be fine. I've seen some nurses try to be heros; afraid to admit something was over there heads. It happens in private duty more than it should- especially when nurses take cases they really shouldn't. THERE IS NOTHING WRONG WITH DEFERRING TO 911 WHEN NECESSARY!! In one very specific scenario, the nurse didn't call for help to others in the house and didn't call 911 until it was too late-- baby passed away. She has been a RN for over 10 years and was reported to the BON. That was the last private duty case I took for a baby for a while... Very sad story. He was so dear to my heart. :(

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    I believe that it is always better to error on the side of caution.

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    It helps when the nurse on a particular case does mental "dry runs" of the possible emergencies for that type of case. It might help prevent trying to bag a patient using the mouth instead of their trach, for example. Also, check your equipment and such. A couple of my agencies had a block on the flow sheet to check for this. An emergency is not the time to find out that the oxygen tanks are empty.

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