Ever walk into a room and think, "Something isn't quite right?" I'm sure you have, and I personally hate that feeling. I want to know WHY I feel that way, and sometimes, I don't! There isn't enough there to call a rapid response, and I often wish there was something--anything--to justify that nagging feeling...
A patient I had today gave me that awful feeling. I eventually acted upon it, and an ICU eval was in progress as I clocked out.
Ever just go, "Oh, I'm just gonna make the call and see what comes of it"? I hemmed and hawed on this guy until I made the call. I figured, "My job is to monitor and know when something isn't right; it's the docs' job to figure out what it is."
Give an example of when something "just wasn't right," and tell me how it turned out.
EMS brought in an elderly lady who reeked of ETOH and had fallen at home. MD said to give her a couple of bags of fluids and d/c from the ED. She denied injury but I just had a "feeling" and asked for a head CT. He said no, she's altered because of the ETOH. I said a head CT won't hurt anything. He kept insisting it wasn't needed. Fortunately, the MD who was in charge of the ER group was there that night and I ran it by him. He ordered the CT and as it turned out, she had a huge head bleed and had to be flown out. I was a new grad at the time...all I can say is never ignore your gut!
This wasn't on the floor....this was at home. DH was scheduled for Sx for his hyperparathyroidism. (His initial Dx for that was 28 yrs prior. ) He didn't want anyone "cutting his throat open". Anyway, in the days prior to Sx, he started getting his affairs in order. He talked about this sense of foreboding and I tried to get him to call his MD about it. DH scared the living **** outta me....
After his Sx and D/C, he skyped me from MD's house (they were personal friends). Turns out that when they looked at his pre-Sx labs, they ordered a repeat because the MD didn't believe they could be correct! After Sx, the MD said that he has been doing these his whole career and hadn't seen PTH and Ca+ levels that high in a living, conscious pt!
He was dying. If he hadn't had the Sx this time, he would not have lived much longer.
Doctor was debating intubating a patient before transferring to the unit. I said yes, that the versed drip had been ordered from pharmacy, the intubation kit was out, and I just needed to call respiratory. Totally bypassed the propofol because while yes, there was a decent pressure I just had that feeling. Patient went into shock not long after they reached the unit and coded the next day.
Specializes in Emergency/Trauma/Critical Care Nursing.
When I was a new grad, EMS brought in a pt seizing for over 20 minutes despite multiple medications. We gave him more medications and eventually the seizure stopped. We took him for a head CT which was negative, however, hours later he still remained completely unresponsive. I noticed that he had pinpoint pupils, saw his tox screen was negative for opiates, talked to pharmacy who said the Ativan and Dilantin should've dilated his pupils if anything, and talked to a fellow nurse who said that seizures would cause dilated pupils. I tried talking to the doc assigned to this pt because I had a bad feeling and could not explain his pinpoint pupils. That doc blew me off and said "the CT was fine, he's just post-ictal, I'm not worried about it".
Well I was worried about it, and when the next shift's doc came on, I asked her what types of things could cause pinpoint pupils in the absence of all the things I had checked, and she said a pontane stroke. So I asked her to come see the pt, explained all of my concerns and that the pt had now put out 2L of urine in the last 30min. All of a sudden this doc began ordering stat neuro consults, MRI, and meds and thanked me for my diligence. Turned out the pt had a pontane stroke and went into SIADH. I have no idea how that pt turned out, but it taught me to never ignore my gut, even when the doctor won't listen to you.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
This wasn't on the floor....this was at home. DH was scheduled for Sx for his hyperparathyroidism. (His initial Dx for that was 28 yrs prior. ) He didn't want anyone "cutting his throat open". Anyway, in the days prior to Sx, he started getting his affairs in order. He talked about this sense of foreboding and I tried to get him to call his MD about it. DH scared the living **** outta me....
After his Sx and D/C, he skyped me from MD's house (they were personal friends). Turns out that when they looked at his pre-Sx labs, they ordered a repeat because the MD didn't believe they could be correct! After Sx, the MD said that he has been doing these his whole career and hadn't seen PTH and Ca+ levels that high in a living, conscious pt!
He was dying. If he hadn't had the Sx this time, he would not have lived much longer.
I'm sorry about your husband -- I hope he's doing well.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
I've seen that used for "symptoms" and less often, "suction". With some nurses it's possible they are talking about "Sux" or "Sex" Just kidding on the last two.
There's a reason our hospital has "gut feeling something is wrong" on the list of reasons nurses can call for the emergency response team. Sometimes we "just know".
Specializes in Care Coordination, MDS, med-surg, Peds.
when I was a new LPN, I had a PT , 88 yrs old. around the clock IM demerol. x 3 days. the 4th day, I found her shaving sezures practically continually. Called her dr who told me quiet vigourously that there was no way this woman was seizingm that she was faking. 88 yrs old, caround the clock demerol, ESRD and liver failuer.... hummmmmmm wonder what he thought the next morning when she went into grand mal seizures and had to e vented?????
Specializes in 3 years MS/Tele, 10 years total ICU, 5 travel.
I was working med/surg on nights. Had the same patient for 2 nights in a row - young male with crohn's, post resection. He was doing GREAT! Was off the PCA, up walking, one of 2 JP drains out. They were going to pull the other JP in the morning and were talking about sending him home a day or two after.
The last 2 hours of the shift, I got THAT feeling. No idea why, he seemed fine. VS stable, labs okay, incision fine, A&O, denied pain, everything. One last quick check before morning report and the patient was laughing b/c I just kept checking on him. I passed on to the day nurse: "keep watch on him, something just isn't right." Went home worried about the guy. When I came back that night, the day nurse rushed up to me as soon as I got off the elevator. "You were right" she said. Turns out not an hour after I left, the patient's remaining JP drain went from empty to full of stool. His anastomosis had come completely apart and he had to be rushed to emergency surgery!
I still don't know what I picked up on, but I just KNEW something was wrong. And I was right.
One time when the facility I worked in had a low census, it was just me, a nurse tech, and a RRT for 10 patients overnight; when there was a moment where the med pass was done; I went to get my lunch because that inner voice was telling me "something is going to happen."
And boy did it.
As soon as I went back to the unit, one of my pedi pts coded. We were able to get the pt back and send them out, but I knew it was going to happen!
I'm a Rapid Response nurse in an urban trauma hospital. From my perspective there's never a bad reason to call me. If you get a feeling, let me know and I'll come see your patient.
If you're right hopefully we can intervene early and get a good outcome.
If you're wrong (or maybe right but I don't see it yet) then at least the patient is on my radar and I can keep an eye on them.
So call me. I won't be mad and we might all be glad you did. I'll take 100 false alarms to prevent one code.
And if if someone tells you they think they're dying, tell me so that I can RUN.
) He didn't want anyone "cutting his throat open". Anyway, in the days prior to Sx, he started getting his affairs in order. He talked about this sense of foreboding and I tried to get him to call his MD about it. DH scared the living **** outta me....
ScrappytheCoco
288 Posts
EMS brought in an elderly lady who reeked of ETOH and had fallen at home. MD said to give her a couple of bags of fluids and d/c from the ED. She denied injury but I just had a "feeling" and asked for a head CT. He said no, she's altered because of the ETOH. I said a head CT won't hurt anything. He kept insisting it wasn't needed. Fortunately, the MD who was in charge of the ER group was there that night and I ran it by him. He ordered the CT and as it turned out, she had a huge head bleed and had to be flown out. I was a new grad at the time...all I can say is never ignore your gut!