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.
In the ER we received a women by EMS for seizure activity, no prior history. Me and two other nurses looked at her and our hankles went up. He had one more seizure just as she was arriving. We placed her on the monitor, one grabbed the crash cart listening to her hankles, and I started some iv's. While placing the first IV I watched the monitor knowing it was cardiac related and watched as the PVC's became more and more frequent till they ran together into a pulseless Vtach. That's a look on someone's face I'll never forget and thankfully havn't seen that often, the look of struggling when the brain is suddenly deprived of oxygen. If I remember she came back out of it again as with the other episodes and quickly admitted.
A classmate of mine had an eerie episode of a 6th sense when we were in our 3rd med-surg rotation. She answered a call light and the lady requested pain meds for her neck. Not an unusual request considering the woman had broke her neck or had surgery on her neck about 2 weeks prior (I can't quite remember). She was back in the hospital for observation for something minor and unrelated to her neck. My classmate got an eerie feeling and went to the charge nurse who happened to be the patients nurse. She chalked it up to being an overanxious student and told her that she was too busy. My classmate still had that nagging feeling, consulted the instructor and another nurse who went in and checked on the patient who was now pulseless. A code was called and the lady died sometime later of an acute MI.
My experiences have had better outcomes (knock on wood). While being an CNA, I was chit chatting with a young patient who was in fairly good spirits. I kept having a nagging feeling that something was up but she was laughing and appeared fine. I asked her if it was alright that I took her vitals a bit early and she was fine with it. As it turns out, her pulse ox was 75. (I tried 4 different machines and a variety of fingers to be sure). Turns out she had a hypersensitivity to morphine and they quickly changed her meds. She ended up going home the next day. Another time I had a patient who was really cold. I gave her a blanket and turned up the heat in her room. I checked on her again and she was drenched in sweat but still swearing she was cold. She spiked a 104 F fever when she had been afebrile for her few day stay and had to stay an extra few days. She ended up needing 2 emergency surgeries to drain fluid from her abdomen. I have had other experiences that have been fairly minor as well. Thankfully I work with awesome nurses who always say to trust your gut. They would rather deal with an overanxious CNA than to have a code on their hands.
DT = delirium tremens. It's what you see when a patient starts to withdraw from alcohol. Symptoms are:
agitation
confusion
hallucinations (visual, auditory, tactile)
fever
high blood pressure
sweating
tachycardia
seizures
It needs to be treated right away as it can be fatal (even w/ treatment).
AWAS stands for:
Alcohol Withdrawal Assessment Scoring
You assess the patient at intervals...on Med/Surg it's usually q 4 hrs. The patient is given points for each withdrawal symptom that they are experiencing. Based on the score, there are standing orders to give X amount of X benzodiazepine. Like a sliding scale.
I am more familiar w/ using CIWA (Clinical Institute Withdrawal of Alcohol Assessment) which also gives you a score that you then dose the benzos by.
DT = delirium tremens. It's what you see when a patient starts to withdraw from alcohol. Symptoms are:
agitation
confusion
hallucinations (visual, auditory, tactile)
fever
high blood pressure
sweating
tachycardia
seizures
It needs to be treated right away as it can be fatal (even w/ treatment).
AWAS stands for:
Alcohol Withdrawal Assessment Scoring
You assess the patient at intervals...on Med/Surg it's usually q 4 hrs. The patient is given points for each withdrawal symptom that they are experiencing. Based on the score, there are standing orders to give X amount of X benzodiazepine. Like a sliding scale.
I am more familiar w/ using CIWA (Clinical Institute Withdrawal of Alcohol Assessment) which also gives you a score that you then dose the benzos by.
I'm the nurse, but a few years ago I got into trouble at the beach and almost drowned. I had no ID, no phone, nothing. I woke up in the hospital with my wife standing over me. She explained to me that she was at work teaching when suddenly it just "came over her" that I was in trouble, so she dropped everything and ran to the ER to wait for the ambulance to bring me in. It put the shivers down my spine and still does.
I was an EMT for just shy of 20 years. ANY time a patient looked me in the eye and said "I'm going to die", I uttered "oh sheet" in my head and told whomever was driving that they'd better not dwadle. In all those years, only one patient was wrong. They know and you'd better well believe them!
Had another one recently. Healthy young guy who decided to take a few too many NSAIDs and gave himself a huge bleeding stomach ulcer. GI scoped him at the bedside (I love getting to watch that stuff), and it was pretty obvious that there was a large, pulsating clot at the end of the ulcer. GI said, I think it would be unwise to remove that and we all laughed a little because it looked like the understatement of the year. The plan was to play it conservative and just see if a Protonix drip would start things healing so they could avoid taking him to surgery. The guy was fine all night long - A&O, a little irritable that we kept coming in to look at him, you know - the typical man's man who has never been hospitalized before. GI even came to visit him again at 0630 and he was fine, asking when he could get that **** tube out of his nose.
About 0640 he really started gagging on his tube and his HR shot up in to the 130s. I wasn't super concerned at that point because he was still bleeding and stayed pretty dry because of it - his HR had jumped up every time he had rolled around in the bed or anything all night long, but it had always come back down. I had already given him Zofran so I gave him a tiny dose of Fentanyl to calm him down. He immediately stated he felt better and he stopped gagging, but his HR stayed exactly where it was - mid 130s-140s. That's when the feeling of doom hit.
I just about sprinted over to where the intensivists were giving report, because of course it's at shift change, and said whoever was free needed to come look at my patient because his HR just spiked for no reason and didn't come down. By the time we got back to my room maybe 45 seconds later, his heart rate was 170, he had vomited what looked like a liter of bright red blood, he was white as a sheet and just about unresponsive. I cycled a BP, which had taken less than 15 minutes earlier at 130s/80, and it was in the high 60s systolic. I thought he was going to die right there in front of me. We started running a liter bolus and he perked up and his HR dropped back to 85, but he still bought himself a ticket to having 1/3 of his stomach surgically removed. He was totally fine the next night - except still irritable about being messed with and aggravated at that **** NG tube.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
In the ER we received a women by EMS for seizure activity, no prior history. Me and two other nurses looked at her and our hankles went up. He had one more seizure just as she was arriving. We placed her on the monitor, one grabbed the crash cart listening to her hankles, and I started some iv's. While placing the first IV I watched the monitor knowing it was cardiac related and watched as the PVC's became more and more frequent till they ran together into a pulseless Vtach. That's a look on someone's face I'll never forget and thankfully havn't seen that often, the look of struggling when the brain is suddenly deprived of oxygen. If I remember she came back out of it again as with the other episodes and quickly admitted.
Specializes in Nephrology Home Therapies, Wound Care, Foot Care..
I went over to my mom's house, and she told me I needed to take a look at my step-dad, no details (typical mid-west lack of info). I was about 20 ft away from him, he was sitting in a deck chair, calm and collected. I just KNEW he was having a heart attack, reached for his pulse saying "you have exactly 30 seconds to get in the car or I call 911". Hospital literally a half block away, paramedics 15 minutes away- he got in the car, coded half an hr later. But he made it. The old guy is a master at these situations, appendectomy at 69, prostate cancer at 75. He keeps my mom on her toes. When you know, you know.
twinmommy+2, ADN, BSN, MSN
1,289 Posts
In the ER we received a women by EMS for seizure activity, no prior history. Me and two other nurses looked at her and our hankles went up. He had one more seizure just as she was arriving. We placed her on the monitor, one grabbed the crash cart listening to her hankles, and I started some iv's. While placing the first IV I watched the monitor knowing it was cardiac related and watched as the PVC's became more and more frequent till they ran together into a pulseless Vtach. That's a look on someone's face I'll never forget and thankfully havn't seen that often, the look of struggling when the brain is suddenly deprived of oxygen. If I remember she came back out of it again as with the other episodes and quickly admitted.