Here we go

  1. Okay, OHN nurse here. Employee shows up SOB, diaphoretic,states he has been feeling nauseated since this morning. BP 138/80, HR 72, O2 98% RA. As he sat he started breathing easier. Then he tells me he had a black stool this morning, first ever. He seemed a bit shakey so I checked his blood sugar- 200. He denied any history of diabetes. He denied any chest pain. He said he had to throw up- I went to the bathroom with him and he was unable to throw up. he told me he had a terrible abdomnal procedure 3 years ago and almost died, and that since then he cannot throw up. After all this exertion his sats went to 90. I put on O2 at 2 L and called EMS. They took him to the ED where he was diagnosed with internal bleeding. He was discharged 7 hours later and told to see his doc Monday. My question is did I do the right thing? Would it have been more approppriate to send him to the doc instead of EMS? I was worried about him driving. Should I have had someone come get him (family member)? I was worried he would fall out in the car. I am frustrated. I do not want to send people to the hospital in ambulances that don't need to go. Any help is appreciated! BTW it took a long time to write but all of this happened in 14 minutes...
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    About SaderNurse05

    Joined: Jan '05; Posts: 306; Likes: 106
    Specialty: 2 year(s) of experience in Tele, infectious disease, new OHN!!


  3. by   cmo421
    You did the right thing. almost sounds like an MI. Wonder what his h&h was. Ems is never the wrong thing in a case like that!
  4. by   TazziRN
    You did the right thing. Symptomology indicated GI bleed vs cardiac. Either one can crash into a life-threatening emergency, not someone you want behind the wheel on his way to the doc.
  5. by   ebear
    ABSOLUTELY you did the right thing! GOOD JOB!!! Hmmm.. SOB-diaphoresis-nausea-previous abd. surgery. Possible obstruction???
    Last edit by ebear on Oct 20, '07
  6. by   leslymill
    Pat on the back is all y9ou get from me.
    Any other move would have you even MORE worried.
    Move on the side of caution.
    Internal bleeding can lead to a spiraling case of full blown shock right before your eyes, if he has been compensating with significant loss since that morning.
  7. by   SaderNurse05
    THANKS!!! Was really thinking an atypical MI, his color was so bad.
  8. by   sirI
    What you did was very appropriate. Kudos to you.
  9. by   Sabby_NC
    Good call Sader...You DID GOOD..
  10. by   Christie RN2006
    I agree with everyone that you did the right thing! From the symptoms you were describing I was thinking GI bleed... GI bleeders and MI patients can crash fast, so you did the right thing sending him by EMS!!
  11. by   espritjolieRN
    You activated EMS because you were concerned he was at risk for crashing... you were correct as everyone here stated, but because he was discharged hours later and told to see his provider you worried you didn't make the right call. Remember though, that even if he was not at risk for crashing (which again, one could not definitively know) he still needed the kind of workup and monitoring that must be done in a hospital setting.