Originally posted by passing thru
Anytime a patient is breathing more than 36 times a minute, even without any other symptom, intervene!
Don't wait for any tests.
Call the docs.
Most people will crash within an eight hour shift with respirations of 32-36 or more . Respiratory arrest. Yes, sinus rhythm ...but they stop breathing.
I've seen nurses actually stand at the bedside watching patients on a monitor and not recognize a crisis, watching and commenting that "the heart rate is sinus rhythm," and although concerned that the respiratory rate was 40-50, continue to focus on "everything will be allright because she is in sinus rhythm."
I have been in the room with those nurses when they say that and still standing & looking at the patient when the patient suffers a respiratory arrest. The nurses are always puzzled. ?
They simply cannot and do not make the distinction between a cardiac arrest and a respiratory arrest.
You simply can't breathe that fast for 8 hours & longer without O2 support and will require ventilator support. (Exhaustion)
If I come on and find a patient breathing 40 times a minute....
they are "working"....it doesn't matter which doc, who or what,
I start calling everybody, docs, supervisors, all docs, ICU to get a bed available....because it is simply a matter of time.
I tell the docs , this patient HAS to transer to ICU.
If the patient is in any kind of distress, it is only going to go downhill from there.
Thanks for responding Wanda. We WERE intervening. That's the whole point. While they were ordering a pulse ox machine, I was on the phone with two docs.
Being a med-surg nurse for many years, I usually can tell when a patient is going to crash, and one can't sustain 40 breaths of minute for long. I agree with you there.
But also there is a point sometimes where if you give the antibiodics, tylenol, etc. A patient responds. I think this is what they were thinking, and I've seen many a patient get well who during the acute phase of their illness breathed 40. But sustained over an 8 hour shift? No, they can't breath that fast for long. The problem being unbeknownst to us the Xray was worse than radiolgist reported. He reported pneumonia on the left side, which isn't always a life-threatening emergency. The pulmonologist who came in said ARDS, it was then we had to move her to the unit.
It was then then docs were told the cause was probably her untreated abcess, it was then gyn decided the nurses were the one's mismanaging her. Not true, as soon as I saw the patient, I was intervening.
Edited to add: What does whether or not a patient is in resp. distress have to do with whether a patient is in sinus or not??? That's scarey.
Also, when we got to the unit and I check on the patient later she was doing o.k. The critical care nurse said she didn't see where the patient was critical. That's the problem with our hospital and the shortage of critical care beds and critical care nurses a patient actually has to be in respirator failure, rather than have the potential for failure to be considered critical. We have to be unsafely particular sometimes who we send to the unit, because someone who really needs the bed won't have one when needed.