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Inadequacy and Incompetence

I am an A & ED nurse. I had this major lapse? with one of the patients I was handling to be admitted. He was rushed at the ED, uncoscious and unresponsive. Assessment were as follows: GCS 5 upon neuro evaluation. Vital signs showes an elevated BP: 240/100. The physician deemed the patient to have suffered CVA. We have donE everything that was required, but we did not consider to perform an RBS up until the patient was endorsed to the next shift. The patient was already intubated when the RBS was done, he had an episode of hypoglycemia. So, immediately they gave the patient D5050 for that. His level of sensorium improved significantly, probably GCS 15 without the barrier.

Upon knowing all these information, I was really shocked and awfully frustrated. I feel inefficient and lower than dirt right now. I am also thinking of legal implications it might bring forth.

What are your thoughts on this?

Kitiger, RN

Specializes in Private Duty Pediatrics. Has 40 years experience.

What is RBS?


Specializes in ICU, Med-Surg, Float. Has 16 years experience.

What is RBS?

Random blood sugar, I THINK 🤔

pockunit, ADN, RN

Specializes in Emergency; med-surg; mat-child. Has 5 years experience.

Tuck this into the back of your head and use it in the future. Now, when you have any neuro patient, instead of ABC, it's ABCDEFG: airway, breathing, circulation, don't ever forget glucose.

I hardly think your license is in jeopardy. Was the pt ok? Why did the doc not consider low blood sugar?

Lev, BSN, RN

Specializes in Emergency - CEN. Has 7 years experience.

Did you do labs on this patient? A glucose level should have been part of the BNP. This was not just on you. This was on the lab and the provider.

EMS is supposed to do a d-stick on anyone who has altered level of consciousness. A blood sugar level is part of any stroke workup. You won't lose your license over this, but you will learn for next time.

We do finger sticks on anyone who is AMS even if EMS did one. Any suspicion of stroke we also do a finger stick even if they aren't altered. Tuck this one away for future practice.


Specializes in critical care.

I had a guy sent to me. Active abdominal bleed. Rushed up from ED. Spent the night just keeping him alive (on step down, mind you, not ICU). Next morning during report, receiving nurse says, "what did the CT show?" I stammered as I realized... They never got one downstairs. And... I never realized it or even asked about it.

"Patient is admitted for GI bleed". You'd think the next question would be from where? He was such a mess (filthy) when he got to me that I never asked. I knew how rushed he'd been and got such a crappy report from the ED RN that I just accepted the handoff as it was.

Just know the outcome was good and that is what mattered. It was for my guy, too, and I KNOW I will never forget to ask what a CT said ever again.

canoehead, BSN, RN

Specializes in ER. Has 30 years experience.

That mistake was a group project. Huge brain fart, but I assume the patient recovered. You'll never forget again, I bet.


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