New Grad, new job... My First emergency!

[beatrice1]

I am a new Grad landed a job in LTC which I LOVE! I have been on the job for 3 months now. I am still learning alot and not too sure of myself. Everyone says "use your nursing judgement" but it's hard when you don't have any experience.

Last night I had a resident who came to me to say she "just didn't feel right" She said she was dizzy and her head hurt. I took her vital signs... pulse was 180! I thought something was wrong with the pulseox, I have never heard of a pulse getting that high. I tried to take her b/p. could not hear anything, tried both arms. couldn't get it. I called another nurse in (the LPN that was passing meds) I asked her to try. she couldn't either. I immediately called her doctor and reported it and he said to send her out to the ER. Did all the necessary paperwork while the other nurse sat with her.

This was the first time I had an emergency, first time I even had to call the doctor first time filling out all the paperwork...ect. I was so overwhelmed, I feel like all my assessment skills went out the window.

Could someone give me feedback as to what more I could have/ or should have done. I would appreciate it.

and has anyone ever seen a pulse rate this high?

(she has history of A-fib and MV repair)

Thanks,

Bea

[laderalis]

Years ago (EMS training) I learned about using vagal manuevers, but were cautioned about trying it with the elderly (because you don't want them to vagal down to cardiac arrest, say). I still kind of think all you'd get with the elderly is a code brown. Just my hunch, however.

Tried it not too long ago with a younger man in SVT - no dice.

code brown. the visual of that made me laugh so hard I almost woke up my napping kid. lol EMS/ER probably wouldn't appreciate it either. :rotfl:

[akulahawkRN, ADN, RN, EMT-P]

As a nurse, I've only seen heart rates that high in newborns :)

As a patient though, I have had two episodes of SVT, and both times, my heart was going at about 240. I kid you not. I counted it myself -- carotid pulse, 6 second count multiplied by 10, and yes, it is difficult to count. I was so shocked by the number I was getting that I checked several times.

Both episodes were preceded by about 5 seconds of extreme dizziness. Only other symptoms were the extremely rapid heart rate, tightness (but not pain) in my chest, and feeling a bit too cold. The first episode resolved on its own in about 5 minutes. I had called the on call doctor at my PMD's office, and by the time they called back, it had stopped. They told me if it happened again I should go to the ER.

Next time it happened, about 5 months ago, I called 911. Normally I'm an easy stick, but it took the paramedics 4 tries to get an IV in (blood doesn't circulate efficiently when your heart is beating that fast) and two tries at getting the right dose of adenosine (which makes your heart stop for several seconds and was the most indescribably horrible thing I've ever felt in my life) before they got my heart rate back to normal. My heart had been beating a good 30 minutes at that rate -- it was such a relief when they finally got it to go back to normal!

Lots of things can trigger SVT, but in my case the likely culprit was caffeine -- during my first episode, I had had 5 cups of coffee on an empty stomach!!! These days I limit myself to at most one caffeinated beverage per day, and even that's probably too much (but I can't quite quit entirely).

Anyway, don't mean to hijack the thread, but since we're on the topic of things that can cause ridiculously high heart rates in adults, thought I'd share my experience.

OP, I think you did exactly the right thing for your patient, including calling a more experienced nurse to help you deal with the situation. Next time one of your patients has a high heart rate, you'll know it's likely real (though double checking manually is, of course, an excellent idea!). Chalk it up as experience, and give yourself a pat on the back for doing the right thing!

Adenosine is given 6mg RAPID IV push. If that doesn't work, then you get 12mg RAPID IV push. As you've found out, it's guaranteed to be one of the weirdest feelings in your chest... Caffeine in high amounts can very much cause SVT or even short runs of VT.

[55nt29x]

I think you did great great, especially since this was your first emergency. A good reminder to always take our patients seriously when they tell us they "just don't feel right". Great job!

[sapphire18]

I consider RVR to be 130 or above...