Sure signs your pt. is sick

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i'm new to nursing and working in an ER and just starting to pick up on the more obvious signs that my pt. is sick.

-chief complaint: apnea

additional obvious additions are welcome

dan

True, but another late sign.

Not really. It is a good indicator of the progression of shock however. Studies have correlated higher levels with worsened outcomes. However resolution of elevated serum lactate is considered a positive prognostic indicator. It is a rather objective "sign" in this case. Signs such as blood pressure, cardiac output, and even heart rate can be misleading and not a true indication of the seriousness of the patients condition. Hyperdynamic septic shock anybody? However, serum lactate levels are pretty specific to the presence of an ongoing shock state.

Additionally, I think the associated saying "leave em dead" is not a very accurate description of norepinephrine. In fact, norepinephrine is considered a great front line vasopressor for septic shock patients with refractory hypotension. (Unresponsive to initial fluid resuscitation.) The strong alpha effects of norepinephrine can be very helpful for patients experiencing redistribution types of shock.

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Cold and sweaty always gets my attention!

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Specializes in ED/trauma.

If your pt looks healthy as a horse, but is anxious and says, ''I'm gonna die" they to me are the sickest person in the hospital and you better get ready for a code STAT!!

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What do you mean by "sick"? I think I'm missing something here...but if a patient comes to the ER, that's a really big sign he/she is sick!

Assuming you are serious, no.

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Specializes in ICU.
If your pt looks healthy as a horse, but is anxious and says, ''I'm gonna die" they to me are the sickest person in the hospital and you better get ready for a code STAT!!

Oh, I forget about that one. I have had 3 pts look at me and say this in all seriousness. Every one of them was right.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
What do you mean by "sick"? I think I'm missing something here...but if a patient comes to the ER, that's a really big sign he/she is sick! Did you mean something more?

Many people who aren't really sick use the emergency department as their personal clinic or primary care provider. They'll take up precious time in the ER while trying to get treated for a runny nose, itching, or other petty complaints. They use the ER because they are uninsured and, therefore, cannot access a family practice doctor.

Many people who aren't truly sick use the emergency department as a means to get scripts for narcotic pain medication.

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Specializes in psych, addictions, hospice, education.

I'm very aware people use the ER as their personal clinic and source for narcotics. I think these things are their own form of sickness too. What I was asking was what the OP mean by "sick". I merely wanted clarification.

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Specializes in Cardiac.

Additionally, I think the associated saying "leave em dead" is not a very accurate description of norepinephrine..

Gotta agree. Levo is great! I think that phrase is just old school. I never hear anyone say it anymore.

Levo is first line drug of choice in sepsis and I can mix it in under 2 minutes.

For me in the ICU, it's the sudden change in mentation. The normally nice lady that all of a sudden isn't nice anymore. Or those people who just can't sit still. They are so ancy....ancy plus mentation change=bad news.

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If your pt looks healthy as a horse, but is anxious and says, ''I'm gonna die" they to me are the sickest person in the hospital and you better get ready for a code STAT!!

i just had a patient on friday do this.

he went as far as asking how much time/ minutes he had left.

hes dead now.

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Specializes in ER.

Silence from the patient, if they're quiet they are feeling to bad to tell their story- that's always a bad sign.

Anyone with a sudden, urgent need to poop, like a woman saying she has to push, it's not the BM you should be worried about.

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
what do you mean by "sick"? i think i'm missing something here...but if a patient comes to the er, that's a really big sign he/she is sick! did you mean something more?

um, yes, you're missing something here. if a patient comes to the er, it may be a sign he/she can't afford (or doesn't want to spend money that could be spent on booze, recreational pharmaceuticals or cigarettes) to go to a primary care physician for a pregnancy test, sonogram or back pain they've had since 1987.

if a patient comes to the er, it may be a sign that their threat to commit suicide if their loved one/child/significant other continued to date "that person of xxxxxx race/religion", didn't come home for thanksgiving, forgot their "month-a-aversary" again was no longer achieving the desired results and more significant action had to be taken.

if a patient comes to the er, it may be a sign that they're bored or lonely and have nothing better to do on a saturday night.

if a patient is wheeled into the er with ems doing active cpr, it's a sign that they're sick.

ruby (who knows this even though she works in the icu and presumably -- but not always -- the patient has already been evaluated and deemed to be sick.)

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What do you mean by "sick"? I think I'm missing something here...but if a patient comes to the ER, that's a really big sign he/she is sick! Did you mean something more?

You must have never worked in an ER. So the patient I had last week that came in because he couldnt sleep was a sign of sickness?

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