RRT vs ICU transfer

[kflavi2]

I want your opinions …tell me if i should have still sent this guy to the unit?

Relevant hx: chf, esrd, dm, severe pvd. Lasix drip DCed around 1pm. Pt returned from first HD treatment around 530pm.

708pm. pt enters junctional rhythm. Symptomatic bradycardia (30-40s). VERY weak peripheral and apical pulses. Lethargic, but arousable. Confused. Hypotension (90/40…manual). Randomly hyperglycemic (412) after not eating all day and coming back from HD.

Call to cards … Start dopamine at 5mcgs and transfer to unit. Consult Dr BlahBlah as intensivist.

Started dopamine. Corrected hyperglycemia.

Call to Dr BlahBlah….agrees with dopamine and a transfer to the unit.

So after doing all that and making the correct phone calls to charge nurses and the ICU …it's about 845pm. And the dopamine increased his CO. As soon as his HR got above 60, he converted to sinus rhythm. The insulin corrected the confusion and lethargy.

So my report to the ICU RN went something like so um don't hate me, but I kinda just fixed him.”

Soooo guys … Would you have kept the patient on the floor after he was stabilized? If I would have called a rapid, that's what would have happened. But honestly … Calling back cards and intensivist didn't really seem like an option. Haha guys never mind”

[Maevish, ASN, RN]

I work in ICU and I agree with the other posters saying getting him to ICU would still be good for him, at least for a day or two. You never know what might happen and he could have more problems later. I mean, it's good that he got stabilized, but you never know how long that will last before something else (and maybe something way worse) happens.

xo

[HopefulICURN]

As someone that works the ICU and gets patients that were "fixed" on the floor, the very often break themselves again. I would have gladly accepted a stable transfer!