Quick Decision Making Example?

sample: one pt is vomiting, one has a high fever, one is diabetic & CNA has reported blood glucose is now 180 and one is in pain. Who gets your attention first? I would say the one who is vomiting as they might aspirate. Next, take care of the fever, then the BS and then the pain. Or I might exchange pain for BS, depending on how the BS has been running up till now. 180 is high but not life threatening usually and the pain in this scenario is not measured and could possibly not be severe.

forgot someothing - consider Maslows. Usually the first thing to do has to do with patient SAFETY

Thank you for that example! :-)

Walked past an ER patients door, saw him pouring large quantity of Tylenol #3 from bottle into mouth (suicide attempt) told him to stop as I approached but he had them all in his mouth by the time I got to him. Had a moment of inspiration, applied cricoid pressure so that he couldn't swallow any. After about 30 seconds the foul taste got to him and he spit them out.

You're floated to another unit. Pt you have there has been a patient there for several weeks and all of the nurses are familiar with him. Pt looks pale and diaphoretic to you. Other nurses tell you this is his norm. Pt is a bit tachy. Other nurses tell you he runs this way. House doctor comes and sees patient. Decides his symptoms are from constipation. Oders an abdominal flat plate, which the doctor says is consistent with constipation. Laxatives are ordered. You really don't feel like he looks okay, but everyone else with more medical knowledge and more experience with this patient thinks he's fine. Do you go above them and page the attending at home at 2am?

I didn't. The patient arrested at 7am. Just one of many examples where fast decision making necessary. Since then I have had other examples where I have called people at home unnecessarily, and where should have called people at home, and where I appropriately called people at home.

I had two patients try to kill themselves at the same time on an unlocked psych unit. One by hanging and one by wrist-slicing. I was the only staff person on the unit. I pushed the slicer to the ground and held her hands apart and put pressure on the wrist, and had two other patients get the hanger down and another patient go get help. Both survived but I wasn't sure I would.

I had two patients try to kill themselves at the same time on an unlocked psych unit. One by hanging and one by wrist-slicing. I was the only staff person on the unit. I pushed the slicer to the ground and held her hands apart and put pressure on the wrist, and had two other patients get the hanger down and another patient go get help. Both survived but I wasn't sure I would.

Can I share this article with others... I found it very helpful :tku: