Pt with fluid filled lung is urgent isn't it?

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Specializes in Med/Surg.

I was at the nursing station and I answered the phone. This woman was at home and was looking for a particular doctor who happened to be near the station. The patient was wanting to know the results of a CXR she had done earlier in the day. The doctor asked me to pull the results up. The report said that the entire left lung was fluid filled and suggested a thoracentesis. The doctor told the patient that she had fluid in her left lung but not to worry about it, come to the office in the morning and get an RX for some antibiotics. I was flabbergasted. I asked the doctor. Did you read the radiologists suggestion? He said yes it's no emergency I assure this can wait.

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it's certainly urgent.

i'm certainly not understanding waiting til morning to get started on abx.

i would think iv or im loading dose would be started immediately.

good chance pt is presenting stable and w/o any concerning sob/dyspnea.

leslie

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Specializes in Med-Surg.

That does sound bad when it says "entire left lung" . You also have to consider the patient's status. Were they symptomatic in a critical or serious way? Hypoxic? In distress?

Perhaps conservative treatment is warranted before poking needles in someone's chest risking complications.

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Specializes in ICU/Critical Care.

Yeah let's wait until she can make in to the doc's office...........oh wait she probably WON"T make it.

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Specializes in Med-Surg.
Yeah let's wait until she can make in to the doc's office...........oh wait she probably WON"T make it.

Hopefully the doc knows the patient. Maybe it's close to their baseline.

Kind of like what they teach in school....treat the patient, look at the patient, not what a machine or reading tells you.

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Specializes in ICU/Critical Care.
Hopefully the doc knows the patient. Maybe it's close to their baseline.

Kind of like what they teach in school....treat the patient, look at the patient, not what a machine or reading tells you.

Good point. It's kind of like running into your patient's room because you see SVT on the monitor only to find out the RT is doing chest PT. Well not exactly like that.

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Specializes in Med/Surg.

Fluid filled lung close to a base line? I wouldn't think so.

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Specializes in Gyn Onc, OB, L&D, HH/Hospice/Palliative.

some pts may have pleural effusions as their 'baseline' as with lung ca or some gyn ca's, just as they may have ascites 2/2 different types of cancer or cirrhosis. Some pt's do walk around and get tapped every so often as a palliative measure, some may have tenkoff (peritoneal) or denver( pleural) caths in place to do this on a reg schedule @ home as well, JM experience...

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Specializes in ER/Trauma.

There is a fine line between "don't fix what ain't broke" Vs "waiting till someone becomes symptomatic" before taking action.

For all we know, Doc may have initiated some kind of intervention already (maybe lasix or some such?)

Fluid filled lung close to a base line? I wouldn't think so.
One of our frequent fliers has only one lung. No only does he get by just fine, he also insists on getting rip roaring drunk in public, necessitating his transport to our ED and ends up bothering us with his rude and obnoxious behavior (q 4-5 days).

cheers,

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Specializes in Med-Surg.
Fluid filled lung close to a base line? I wouldn't think so.

I wouldn't think so either given the extent of this one, but many people have chronic pleural effusions.

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perhaps one of the most important pieces of information i was taught in nursing school by the great mr. W is, is this patient symptomatic? Alert? Oriented? Normal respirations? Good O2 sats? No distress noted?

The report could have said that both lungs were missing - but if the patient was up and talking and breathing fine, then it is not a "true emergency".

same principle for a low BP. you take a BP and it's 23/12. the patient is alert, talking to family, and appears to be fine. are you going to start screaming and begin cpr? however, you may want to report a bp like that to the physician stat :)

25% assessment, 25% intervention, 50% common sense = a good health practitioner!

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Fluid filled lung close to a base line? I wouldn't think so.

non-compliant CHFers often have lung water as a baseline.

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