Dumping on the ER?

Nurses General Nursing

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Hi guys. Little background I am a novice nurse working in LTC. Been a medic since I was 21 and was also a pct since I was 18 so I am not "stupid" but sometimes I feel that way when I send PTs out to ER.

tonight I sent a pt with hx of HTN, and a-fib and a newly fractured femur to the ER. My reason, her HR was more thready and irregular than usual and her BP was 160/110. I didn't want her to have a stroke.. She's got the a-fib, fracture and high BP risking her for blood clots and stroke. So although her family was against it I sent her out. The ER nurse in report said, if she has a hist of a-fib then the irreg heart beat isn't so much of a concern. I said yes but I am more worried about her BP and risk for clots. She is on warfarin for the fib but still, better safe than sorry. Or am I wrong?

i send out people because I do not have the resources at my facility do treat people as an ER would but I only send them for really abnormal or major things..

im just trying to get oter people's input to see if I did the right thing or if I am being over-caughtous and dumping on the ER?

Specializes in Emergency, Trauma, Critical Care.

For a bp of 160 /110 we dont even usually treat in ER. Is she on BP meds? When was her last dose? Is she in pain? I would have called her doc if the bp was abnormal for her or was in pain and let them decide if she needed anything. If she has no other symptoms, i wouldn't have sent her to an ER. I would recheck her BP later in shift to trend it.

For a bp of 160 /110 we dont even usually treat in ER. Is she on BP meds? When was her last dose? Is she in pain? I would have called her doc if the bp was abnormal for her or was in pain and let them decide if she needed anything. If she has no other symptoms, i wouldn't have sent her to an ER. I would recheck her BP later in shift to trend it.

Yes on meds and dose was given twice.. Last one was given at dinner. I don't have doctors or even any other nurses physically at my facility.. It's just me and my CNAs. So I really don't know sometimes what to do. The systolic didn't concern me nearly as much as the diastolic

Also called her doc and left word with on call service can never get in touch with him it sucks. He follows up on things like days later. She wasn't in pain or anxious.. Was laying down the whole night.. I checked 3x and BP meds didn't bring it down at all.. But there's no nurse over night.. Only a med tech and CNAs.. I just thought it'd be better to stabilize her God forbid anything were to happen after I left since this happened close to the end of my shift

Specializes in Emergency Medicine.

I'm confused by "more thready and irregular." Afib is irregularly irregular- unless she was in rvr, then how do you know it was more irregular? For that BP we would do nothing in the ED, especially if not symptomatic. If she has a fresh femur fx you worry about a PE, but she had no sxs of that- no tachycardia, no SOB, no CP. I would have medicated the pt with pain meds which is more than likely the cause of the increased BP. Plus, she is in Coumadin and in assuming gets her levels checked regularly- it's pretty unlikely for her to have a clot. Like I said, at risk for emboli due to femur fx, but she had no other sxs to indicate that.

Additionally, if the family did not want her sent, I would not have sent her. There is nothing you've said in your statement that I believe the pt needed to be in the ER for.

Specializes in Emergency Medicine.
Also called her doc and left word with on call service can never get in touch with him it sucks. He follows up on things like days later. She wasn't in pain or anxious.. Was laying down the whole night.. I checked 3x and BP meds didn't bring it down at all.. But there's no nurse over night.. Only a med tech and CNAs.. I just thought it'd be better to stabilize her God forbid anything were to happen after I left since this happened close to the end of my shift

She was stable, there is nothing to stabilize.

Idk. This is why I feel dumb sometimes and why I asked. She had a hist of a-fib but since she's been with us she hasn't had an irregular pulse. I see the other nurses doing things like this and so I get confused.

Specializes in Emergency/Trauma/LDRP/Ortho ASC.
Idk. This is why I feel dumb sometimes and why I asked. She had a hist of a-fib but since she's been with us she hasn't had an irregular pulse. I see the other nurses doing things like this and so I get confused.

If if her afib is historical and her rate controlled...an irregular pulse is nothing to be concerned about. I mean this in all kindness...do you know what a thready pulse means? I totally agree with PPs...there is no need for this pt to be stabilized in the Emergency Deparment. I would have assessed the need for pain medication and moved on. You aren't stupid...these things come with time and experience is the only way to learn.

If if her afib is historical and her rate controlled...an irregular pulse is nothing to be concerned about. I mean this in all kindness...do you know what a thready pulse means? I totally agree with PPs...there is no need for this pt to be stabilized in the Emergency Deparment. I would have assessed the need for pain medication and moved on. You aren't stupid...these things come with time and experience is the only way to learn.

Yeah I asked if she was in pain.. She said no. Offered her meds but she refused. Her bp has been generally on the low side so I guess I saw a red flag when it got high and I get really nervous sometimes. But I will keep this all in mind for next time.

I'm so confused now.. My overnight tech texted me that the daughter called our facility from ER, stated that PT had non-st elevated MI.. Will be staying there for monitoring.

It's not what I sent her there for I just saw red flags.

Specializes in Trauma, Teaching.

So one by one the things you described weren't enough to warrent sending her, but you added everything together and knew something just wasn't right. Err on the side of safety and it paid off for you!

So one by one the things you described weren't enough to warrent sending her, but you added everything together and knew something just wasn't right. Err on the side of safety and it paid off for you!

Yes I just wish I would have pieced it all together myself.. I wanna be a good nurse and use good judgement all the time. it's just so hard when I'm so new, and I have no other nurse physically there with me. Sometimes my coworkers and supervisor pick up the phone right away and sometimes they don't. I feel like I picked up on certain things and then the ER had to evaluate. But at least we got it right away before it got too bad. I mean I've seen MI cause BP way higher.. And she had no c/o chest pains. I knew, but I didn't know lol

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