The Gut Feeling...

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How do you adequately articulate to a doctor that you feel a patient's condition is deteriorating even though you don't quite have proof yet?

My patient was having sustained ST in the high 140s-150s (over 2 hours). She was ordered metoprolol for HR above 130s but earlier in the shift she'd had a BP of 89/50. We were giving a bolus of NS for the BP when the issue with the sustained ST occurred. I lowered the amount of NS we were giving hoping that would help, but it didn't and her BP never did rise. The patient already had AMS, so it was impossible to use that as an assessment tool.

I called the doc twice, but could never quite put my finger on what made me so uneasy besides the above. I got the charge nurse involved because I whole heartedly believe that there was something really wrong. Just before change of shift we got back the patient's AM labs back and it was obvious that there was some sort of infectious process going on and the doc then ordered appropriate tests to obtain a diagnosis.

I have been off the last few days so I'm not sure of the patient's outcome, but I'm curious if there was anything more that you may have done in this situation.

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