How would you have handled this?

[ProBeeRN, BSN, RN]

So here's the basics-

Went to the home of a pleasant 90 year old woman today for an assessment and to set up her meds. When I get there she's not "herself"- a little more confused, stating she's more tired than usual, puts her head down at the table. She seems on the verge of passing out. HR in the 70s with slight irregularity (her baseline). I take a (manual) BP- at first unable to get one, then something along the lines of 30s/teens . She's conscious but lethargic. I try to reposition her to double check BP- she stands with her walker and suddenly starts shaking uncontrollably. I help her down to her chair and call the dtrs cell to take her to ER for eval- she doesnt have a car at work, so we decide I'll call the ambulance. Call ambulance. While waiting, I stay with her and recheck BP again- starting to come up (60s/30s). EMS gets there, we get her out, she's feeling better by this point and is like "oh, I'm fine now, I don't need the hospital". Recheck BP in ambulance- 90s/60s (her normal).

I'm feeling silly. Couldn't get a hold of the doc's office (couldn't get through) so went on my own judgement with the ambulance call. Ended up in ER, not sure if being admitted or just staying for observation. She does have a hx of syncopal episodes along with an extensive cardiac hx. My hubby says to stop second guessing myself and I did the right thing by calling EMS- I mean, I don't have an EKG or anything for further assessments. Nor do I carry IV sets on me for fluids. And at that moment I didn't want to "wait and see"...I mean, what if she went into a full arrest (Been in that situation in another home. NEVER want to do it again)?!

So- did I overreact? Or do the right thing? *Sigh* Almost 2 years as a nurse and still second-guessing myself. How long does that last? :)

[roser13, ASN, RN]

"It" lasts as long as you're a conscientious nurse. You did the right thing.

Failing to obtain emergent assistance, given the current assessment, would have been negligent.

[christieb01]

Sounds to me like you did the right thing. You had know way of knowing when you called the ambulance that she would get better so quickly. Also, there's know way to know if she wouldn't have another episode that may have been worse. Good call in my opinion.

[ProBeeRN, BSN, RN]

Thanks. Had no doubt initially-- did an "oh s--t!" in my head and then kept my head together and took it from there-- it was trying to explain everything to the EMTs-- "but, but, she wasn't stable 5 minutes ago!!!" that made me feel silly. Had a detailed note with BPs, assessment, meds, etc for them to take into the ER though.

[caeRn]

you did the right thing for the patient at that time. you will always second guess urself, atleast I do and have been nurse for 6 years. When another life is in your hands you always question should i could i etc etc. its natural. good call on this case.

[50caliber]

Situation did not turn ugly because she was able to recover by herself. Say you delayed calling for help and she really goes bad. Then you are being negligent and you don't want to go there from a legal stand point.

Good call. You did the right thing. Your options were limited. You are not equipped for an emergency. Like you say, you don't have cardiac monitoring ability with you, you don't carry IVs and fluids, and you don't have emergency meds. Whats the worst that can happen if you called for help vs. not calling for help.

[PAERRN20]

ER nurse here- you did the right thing! We would admit her at my hospital.

[NurseLoveJoy88, ASN, RN]

Good call

[SweetLikeSugar]

I've been a nurse for 8 years and I still have situations where I second guess myself.

And as far as calling EMS, I think you were exactly right in what you did. It's always better to err on the side of caution.

[Super_RN, BSN, RN]

Definitely appropriate. I probably would have called 911 first because I would not be able to dial 7 numnbers, LOL! you'll second guess yourself many times over, but it doesn't mean you made the wrong choice

[SpecialK38, ASN, RN]

I agree- you did the right thing! Don't doubt yourself- go with your training and instincts. I also agree it is always better to err on the side of caution.

[littleannabell]

I agree. you did right thing. I had a lady with 212/90 b/p and family prefered I call ambulance over they driving her. open heart surgery 3 weeks prior. dry heaving during visit. Paramedics made me 2nd guess also after telling family she will be discharged as soon as she gets there because that was not a dangerous b/p. Really!? Make you feel like a real heel in front of family. Pt was kept for several hours and released. Still I would not want something going south on my head!