Systolic in he 300's...no new orders?

Published

Specializes in ICU.

Long story short:

I had: an agitated vent patient with a questionable neuro status, BP would shoot into the 180's just laying there, numerous calls to doc but can't get new orders to manage his sedation or BP any other way (besides 50mcg fentanyl q1hr, and 5mg metoprolol q4.) Roadtrip to CT, BP completely out of control, 300's/200's with a good wave form, pretty much as I expected. We get back, doc notified of situation, still no new orders, but the pressure is stabilizing, amazingly enough, just taking a long time, on top of managing his poor sats, tachy in the 120s, etc. They finally come to the bedside after the pulmonary doc (god bless 'em) notifies them. Orders for haldol just as I am going off shift...

I'm a new nurse (graduated December, 08, oriented from April to October) and I'm just wondering how a more experienced nurse would handle this. I am beating myself up, thinking I should have raised holy hell over the BP and gone up the chain of command immediatly. You better believe...next time I will. Everything is a learning experience and I did the best I could with a lot of support from my co-workers, especially during the road trip, but still feeling stressed over the whole thing, and also like I had my hands tied a little bit.

Up Vote Up Vote ×

This sounds like a silly question, but did you double check the numbers with the cuff pressure?

If the pressure only shot up on a road trip, I would ask for some extra sedation for the next time you take your patient off the unit. Explain to the doc what happened.

Is the patient in withdrawal to be so agitated? Maybe a CIWA protocol? (CIWA is a measure of withdrawal related symptoms and doses of Ativan to be given).

Don't be hard on yourself, you are still new and learning.

Up Vote Up Vote ×
Specializes in ICU.

You know, I didn't check a cuff pressure at the time. It was correlating at the beginning of the shift and I was thinking that since it was a good wave form with a crisp square wave test, double checked the placement of the transducer and made sure the pressure bag was at 300, that it was probably accurate. What are you thoughts on how accurate these indicators are?

Definitely would have wanted more sedation. There were specific reasons why they were really hesitant to give anything more (concerned about clearance, for one,) and I understood their hesitance on that end, but really felt like he needed SOMETHING...still feeling unsure about how hard I should have pushed.

Thanks for you input!

Up Vote Up Vote ×
Specializes in CTICU.

There's something severely wrong with a BP that high, if it truly was. I would have been making a LOT of noise to get orders at that point and mention that if I didn't, I'd be documenting that dr refused and would be calling them when he stroked out!

Up Vote Up Vote ×

I've never seen a blood pressure that high, doesn't even sound physiologically possible. Jeez!

Well for one thing I would learn to NOT travel off the unit under those circumstances. If they code in the elevator on the way back from CT, it's a lot harder to handle the situation with a small box of meds, a transporter and an RT. Patients that unstable shouldn't be traveling.

And definitely push for meds and document document document that you tried to get them. It's sad you've got to wait for them to code before you actually get some orders. You are the patient's advocate. No matter how annoyed the doctors get, you're not there to make friends with everyone, you're there to keep people from passing on the the next life if you can do something about it.

Up Vote Up Vote ×
Specializes in ICU.

Thanks for the input, everyone...really appreciate it. It was a definite learning experience. Next time, I'll do some things differently. My manager pretty much said the same thing you all did...chart, chart, chart. You better believe that doc's name was all over my notes for that day. Ay-yi-yi.

Up Vote Up Vote ×
+ Join the Discussion