Share your story: "I hate it when I'm right!"

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Specializes in Utilization Management.

had a patient a few weeks ago with intense chest pain on deep breath. no labs or tests were done to r/o pe. my gut told me it was a pe, though. so i called the doc (at about 0400), begged for and got orders--and patient turned up positive for a lot of pe's.

i hate it when i'm right.

(btw, pt survived.)

share your story!

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Specializes in Psychiatry.

(BTW, Pt survived.)>>

Well, this is the good part. :)

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good call angie! glad the md listened to you!

i have a story, first of all, i'm not knocking rt's!!! this is just my story!

i had a pt on the vent. vs stable, sats >95, looked good. but......something was wrong. i didn't know what it was, i just knew something was wrong. (it's been a while, so i forget some details) i knew something was wrong with the ett (it wasn't positioned right or something, it just didn't look right). how i knew - i don't know, it was my gut feeling (i call my voice) screaming at me! i asked and asked and asked the rt to double check the pt - completely - vent, ett, breath sounds, everything with me, she did & said everything is fine. no it's not (voice still screaming), by this time, my sats were 93-94%. she still insisted all was ok. i was determined...i paged her every time she left the floor & said something is wrong with the ett, still she insisted all was ok (this went on 15-30 minutes sats stayed >93%)....i then insisted on getting another rt to the bedside. the other rt said..you're right, the cuff has a hole in it.

(pt was fine)

"i hate it when i'm right!"

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Had an unresponsive s/p code pt on Amiodarone gtt. Did my morning ECG strip check and it looked suspicious for 3rd degree block. Showed it to a few other RNs on unit and a Cardiology Fellow who was seeing a pt on the unit (he was not on my pt's team). He agreed that it looked like some sort of AV dissociation. I called the MD and told him, asked for a 12 lead and got the order. The 12 lead confirmed 3rd degree. I was a relatively new RN (9 months) so I asked another nurse if amiodarone gtt could affect the rhythm...she said it should be d/c'ed (I looked it up in my drug book too and found that amiodarone could cause 3rd degree). I called the MD (a second yr resident) and he said they would deal with it on rounds. I did not feel good about this so I pushed a little further and told him I had my drug book open in front of me and that amiodarone is contraindicated in 3 degree HB. Got an order to d/c amiodarone. I also read in my drug book that amiodarone can significantly increase dig levels and noted that the pt had received a dig loading dose the day before. I could not find any dig level so I suggested we check that. MD was not eager to do so but listened to my concerns and said, "Go ahead". Level came back 6.4!! Needless to say the pt received Digibind! The doctor came back later that day and congratulated me on the good call.

Terri

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Specializes in Occ health, Med/surg, ER.

OOOOOH.. Love this thread. Ok, I have some... I was just in nursing school!! Heh.

1. Patient on Mag for preeclampsia was having repeated late decels. Primary nurse disagreed with me "the student nurse" and said the were variable decels. I tried to get the nurse to explain to me how in the world they were variables but she basically just told me "i didnt know what i was talking about". Patient went on like that for a few hours. Doc came in an ordered stat c section for repeat LATE DECELS. I didnt have to say a word. Primary nurse didnt look me in the eye after that.

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Specializes in tele, ICU.
had a patient a few weeks ago with intense chest pain on deep breath. no labs or tests were done to r/o pe. my gut told me it was a pe, though. so i called the doc (at about 0400), begged for and got orders--and patient turned up positive for a lot of pe's.

i hate it when i'm right.

(btw, pt survived.)

share your story!

good for you! how do you r/o pe? how do you treat it? i once asked a former preceptor and she basically said "you can't" though obviously she didn't know what she was talking about. she was not the best teacher, to say the least.

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Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.

A number of years ago my husband's aunt had breast cancer. She had a mastectomy plus other treatment, did fine. Several years after that my sister in law called me one day and said that their aunt was going to the doctor, she was having some abdominal problems.

My immediate response was "she has liver mets from the breast cancer and she's not going to make it."

Unfortunately I was right.

This wasn't me but another nurse in PICU. She was taking care of a fairly fresh open heart baby, I had the kid in the next bed. This nurse started saying that something was wrong, her patient was getting ready to go bad. There wasn't anything specific she could put her finger on but she was sure of it.

We had a new pediatric intensivist who basically blew her off. He didn't see anything, the baby was fine, no need to call the thoracic surgeon.

By the end of the shift we'd coded the baby and it did not survive.

Don't just listen to your own gut, listen to the instincts of other experienced people around you, including techs and CNA's.

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Specializes in Utilization Management.
Good for you! How do you r/o PE? How do you treat it? I once asked a former preceptor and she basically said "you can't" though obviously she didn't know what she was talking about. She was not the best teacher, to say the least.

We usually do a D-Dimer. If it comes up as >1000, then Pt will get either a stat CT angio or a VQ scan.

It's treated with heparin or Lovenox. Some docs want the Pt on bedrest for a day or so, some don't. The patient will usually go home on Coumadin.

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Specializes in Orthosurgery, Rehab, Homecare.
We usually do a D-Dimer. If it comes up as >1000, then Pt will get either a stat CT angio or a VQ scan.

It's treated with heparin or Lovenox. Some docs want the Pt on bedrest for a day or so, some don't. The patient will usually go home on Coumadin.

:yeahthat: Us Too.

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Specializes in Orthosurgery, Rehab, Homecare.

I had an older pt who had a hx of prostate ca with mets- surgically removed, chemo, radiation, "cancer free" x's 6 years. He starts acting kinda weird, less alert, slightly confused. Not as severe as a CVA. MD's think it's the pain meds and sleeping pills he's been taking. He's scheduled for discharge from our acute care rehab to home. They were just gonna have him change meds and follow up with his primary md. I knew something more was wrong. I took the attending aside and said, "Look, you're gonna think I crazy, but please schedule him for a CT. I think he has mets to the brain." He thought it was a longshot for an expensive test, but trusted me.

Come to find out he did have mets to the brain, poor prognosis and went from us to a hospice.

I don't know how I knew it was that specifically. Everyone else thought the Prostate ca was "ancient history", being after the 5 year window and all.

Like someone else said, trust yourself. (And the people you work with.) Even when you hope that you're wrong.

~Jen

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Specializes in Oncology, Neuro-orthopaedic, Medical, Su.

It amazes me that doctors still think that we are not qualified enough to make a call like this. they tend to forget that we spend 12 hours a day with our patients, not just a 2minute round.

I once assisted with a liver biopsy under local. The patient did well and the doctor went for rounds, an hour later the patient started feeling uncomfortable and anxious, phoned the doctor and he said he will come and have a look. Doctor arrives and looks at patient, says its a panic attack or something. I ask for Chest X-ray, he turns round says "why".

I say patient has pneumothorax from liver biopsy - he says "nonsense!", but fine do CXR.

Yes you guessed it! We were inserting a chest drain not too soon after that!

Doc was at least impressed, think he took it to heart that sometimes you have to trust that inner voice, (and classic symptoms of pneumothorax)

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Had a pt who was 1 month post op who arrived with lady partsl bleeding. We did a hcg and found it to be 59000 the equivalent to a 8-10 week pregnacy. They booked OR for D/C for retained uterine particles. I sopke to the doctor and said maybe he should do a exploratory Lap first to see what it was as it could be a choriocarcinoma. He left without saying anything but tonight the OB resident came to me and told me I was right it was a choriocarcinoma. This was the one time I wished I was wrong. ( 5 years as a Gyn/Oncology nurse was not wasted afterall)

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