The correct way to send a patient out to the hospital...

[lvnnars1]

just for clarification. regarding LTC facilities. ok, lets say you have a patient having SOB you check the O2 sat. and it's 84% you give 2 liters of o2 via NC and it's about 86% now, pt. is a code, patient is a&o X3 how would you go about sending this patient out? would you first get an order from the MD first to send the patient out, or do you use your nursing judgement and send out patient then call the doctor after the ambulance picks him up? do you call 911 at all? curious to see your answers.

[rkitty198, BSN, RN]

I am assuming this is homehealth? I recieve patients many times via ambulance called by their homehealth provider.

With the oxygenation issues you described I would think that would be an emergency and what is a doc going to do about it over the phone? You cant drive the client in yourself, so the next thing is to call 911.

[NurseInTexas12]

Are you talking about a clinic setting or LTC? Using common sense to save a patient's life does not require an order. If you have a patient who is having shortness of breath and O2 sats in the 80s in an outpatient setting, you need to address any immediate patient needs and call 911 right away. Of course you'd want to notify the doctor as soon as possible so he could come assist you, but your first responsibility the safety of the patient.

[Altra, BSN, RN]

If I am the patient, how's about more than 2L of O2, please and thank you.

[Crux1024]

Increase O2, nebs? Telling them to take a few deep breaths. All should be done before calling 911 i would think. But of course use your judgement.

Also, I would imagine calling 911 depends on your facilities individual policy. You should know it if youre working there.

[Nascar nurse, ASN, RN]

I initially thought LTC.

If patient is in obvious distress & looks to be circling the drain...911 first!

If resident is somewhat OK despite O2 SAT, I may try to contact MD once. If I can't get ahold of them within a short amount of time, they're going out anyways.

[lvnnars1]

im talking about LTC..

also what type of situations do you use a "non siren ambulance" (not 911)?

[systoly]

Whenever possible, get patient's or POA consent. Have someone make copies, call the doc if time allows and call 911. If you don't have time to call the doc first, do call after the patient has been transported (I forgot that one time - doc was cool about it).

[systoly]

im talking about LTC..

also what type of situations do you use a "non siren ambulance" (not 911)?

non emergent transport, when the patient has to be transported by stretcher for example

[ObtundedRN, BSN, RN]

im talking about LTC..

also what type of situations do you use a "non siren ambulance" (not 911)?

A "non siren ambulance" is called a "Non Emergency Transport" or what we always referred to as a NET call (when I worked EMS. A NET transport would be for non emergencies. Typically scheduled pick ups for appointments or scheduled procedures.

And I agree with previous posters. Try a little more than 2 liters of O2. That's only about 28% FiO2, and room air is about 21%. 2 liters isn't much. And try any PRN nebs, tell them to cough and take deep breaths, etc. If still no improvements, then definetly call 911.

[lvnnars1]

A "non siren ambulance" is called a "Non Emergency Transport" or what we always referred to as a NET call (when I worked EMS. A NET transport would be for non emergencies. Typically scheduled pick ups for appointments or scheduled procedures.

And I agree with previous posters. Try a little more than 2 liters of O2. That's only about 28% FiO2, and room air is about 21%. 2 liters isn't much. And try any PRN nebs, tell them to cough and take deep breaths, etc. If still no improvements, then definetly call 911.

1)-how much more O2 would be OK if patient had a, say, 84% o2 sat, is 6 liters of O2 fine instead of 2 liters?

2)-what else type of situations can we use a "non emergency transport"?? how about if pt. is feeling intolerable pain even after given the prescribed PRN pain meds, would you think it would be OK to send out as a "non emergency transport" for further eval? would you call MD first or use nursing judgement and send out pt. AND THEN call MD.

[ibmanda2000, LVN]

Dont yo have a POC on this patient that states 02 parameters and a med order for the amount of 02 you can give? I worl pediatric home health. If I have a questionable emergency situation where I do not feel 911 is needed, then I call the MD to get feedback on what steps to take next IF my patient is stable! In any case, you would need to use nursing judgement and bump that 02 up as much as needed to get sats aove 90% at least..... unless your patient has emphasema. Good Luck!

did you have a situation like this occur or are you planning ahead?