Nice docs but sometimes frustrated

[zacarias, ASN, RN]

Hey folks,

So last week we had this 300+ lb pt with 13 pressures ulcers, some to the bone and I had noticed that there were two EKGs done within 45 minutes of each other on admission to the hospital. The first one was NSR no problem and the second one had ST elevations and the automated printout said highly indicative of AMI. I told the resident and attending when I saw them because I didn't hear in report that this man had an MI. They said he had a stroke but they would look into it. Of course they never got back to me.

I'm a nurse who digs the medical aspect of everything and it's frustrating that I get no satisfactory response. Of course I'm sure the attending is not thinking that it is priority to get back to a new grad nurse regarding an EKG LOL! Anyway, maybe that's why I keep thinking about med school.

BTW, this pt had chest pain on admission. How could that be anything but an MI even if his Troponin was 0? CP and ST elevations seems diagnostic to me.

[Rapheal]

Could be hyperkalemia. You will see very tall peaked T waves. Was this patient renal insufficient?

[Tweety, BSN, RN]

The classic sign of an MI is the troponin. I can understand in the absence of an elevated troponin one wouldn't necessarily think MI. However, serial labs should have been considered. Any EKG changes should be a red flag and kudos to you for actually looking at them, and actually reporting them.

Chest pain is funny. So many causes including GI. An agina attack doesn't always indicate an MI.

I know what you mean though. I hate when pieces of the puzzle are missing.

[CCU NRS]

Just today I had a Pt with a L Hemi-pariatal bleed with expressive aphasia and excessive HTN 200/100s N E way pt is admitted to the Medical service and the resident on the pager is first year. I call and explain I need something to keep the HTN at bay ok Labetolol 20mg IV q 10/min as needed well three hours later after the Pt has had about 140mg Labetolol I call and say hey NOT working IV Vasotec 1.25 IV now I call back in an hour NO response still 200/100 Increase Vasotec 6.25 mg IV another hour B/P still sky rocketing and I see this resident actually on the unit so I go over and explain that all the Labetolol and vasotec are not working can we maybe get aggressive here Nitro or Nipride gtt she hem haws arond and says well lets give Labetolol 40mg as needed... I call the attending and explain and tel him I think we should start a nitro gtt... Nitro gtt to titrate B/P keep sys B/P 160-170 Thank You

[bellehill, RN]

I don't care how much experience you have, the doctors should always give you a response when you present a problem. If they don't, keep calling and if you have to go above them. This is a huge pet peeve of mine and I have no problem calling multiple times until I hear the answer I want or at least a plan for the pt. Don't give up, you are the pt. advocate!