Treat the Patient, not the Monitor.....Really?

[jk2185]

This is my least favorite "go-to" that I hear all to often. Why even have monitoring in the first place? I trust the monitors more than my own ability to intuitively know a patient's condition based on my limited assessment skills; and just to ward off evil comments spawning from this notion I want to remind everyone that we all have limited assessment skills, our senses can only do so much. And of course, if your monitor screams asystole or vfib and your patient is smiling at you politely asking for more apple juice, I do hope that we all know to check lead placement or something.

We didn't have numbers 100 years ago and look what kind of healthcare we had...not the greatest.

I just wish we could flush this saying out or maybe change it.

[jk2185, BSN, RN]

Well no duh!!! Of course if your patient looks horrid and the monitor doesn't reflect that you should most definitely perk up and do some investigating.

Im regretting this post!

Your assessment skills can fail you just as badly as a monitor can, we have to use ALL THE DATA at our disposal.

[Horseshoe, BSN, RN]

You seem kind of upset that very few people get worked up about that saying and actually see some truth in it. Sorry.

[missmollie, ADN, BSN, RN]

OP, If you don't mind my asking, how long have you been a nurse?

[Been there,done that, ASN, RN]

This old school chick has witnessed doctors and nurses treating the monitor without assessing the patient.

Resident giving a precordial thump... for artifact.

"Treat the patient ...not the monitor", is indeed an old school phrase. That many newer practitioners still cannot put together.

It's good that YOU can put it together. Of course we need to rely equally on technology and our assessment skills.

Six years.. you are still wet behind the ears. Too soon to question old school.

[Been there,done that, ASN, RN]

Well no duh!!! Of course if your patient looks horrid and the monitor doesn't reflect that you should most definitely perk up and do some investigating.

Im regretting this post!

Your assessment skills can fail you just as badly as a monitor can, we have to use ALL THE DATA at our disposal.

"Im regretting this post! " Why would you regret it? You have started an intelligent conversation on your topic. Wimping out?

[Krzysztof]

Im regretting this post!

Nah.

These experienced guys and gals give us newer guys and gals a ton of valuable tidbits to consider. Just gotta develop a taste for the salt it's sometimes served with.

[jk2185, BSN, RN]

Thanks everyone for weighing in....this post didn't go where I thought it would, I apologize for the confusion.

[heron, ASN, RN]

"Look at the patient, not the monitor" doesn't work for me either. I've seen plenty of patients that look fine chatting away with a CI of 1.8 or an SBP around 200. So...as long as my equipment is calibrated correctly and not being assessed by someone who doesn't know how to properly use the devices, more often than not, I believe what my monitor tells me 100%.

Your story is interesting and it sounds like it made for a terribly stressful day. Seems to me there may have been a failure in protocols. Did anyone check a pulse or responsiveness? Even if a monitor shows a shockable rhythm you still follow the BLS survey first. It also seems odd that the monitor in room A (which was presumably hooked directly up to the patient in room A) would show data from a different room. I'm no IT guy for sure, just seems very odd.

I'd say my point of view only works if you know what you are doing. It doesn't work if you put the wrong size BP cuff on a patient, or if you have bubbles in your pressure lines, or if you don't check your patient's pulse and responsiveness when you have some strange artifact that often does look fib-ish.

I just find this old expression to be only mildly useful. Of course you use your intuition and assessment skills, but the notion that you should treat based on what you see over data drawn from high-tech equipment seems a little over the top.

I think treating the patient and the monitor should be on an equal plane....use all the data you can get.

Seems like you're saying the same thing, then. Your first response to badness on a monitor is to actually look at the patient and suss out what's going on before deciding to assault her with electricity, toxic chemicals or procedures that hurt and make her bleed.

The saying is a short and sweet reminder of that. Don't take it personally. As my favorite drinkers say: take what you need and leave the rest.

[Guttercat, ASN, RN]

Numbers have been around far longer than a century. Just saying.

I'm sorry you dislike the expression. Does "look at the patient, not the monitor" appeal to you instead?

Years ago -- decades ago, actually -- I worked in an old, decrepit hospital. A brand new hospital was built, and many new nurses were hired to staff the additional beds the new hospital afforded. Moving day came, and we moved into the MICU with it's bright, shiny new, state-of-the-art monitors. The first patient was moved in and hooked up to the monitor with a lot of fumbling because the monitors were new and unfamiliar. The second patient was moved in and also hooked up to the monitor . . . And so forth. Not long afterward, the nurses were gathered around the nurse's station when the monitor alarm went off. Patient 1 was in ventricular tachycardia. Everyone went rushing into his room with the code cart and code drugs, following accepted ACLS protocol. The rhythm deteriorated from ventricular tachycardia to ventricular fibrillation to asystole, despite the interventions. Then a wondrous thing happened . . . The patient began to strenuously object to defibrillation and chest compressions despite the asystole on the monitor.

During the construction process, somehow the monitoring wires in the two adjoining rooms was crossed. Patient 1 wasn't in asystole; Patient 2 was. And because all those brand new nurses and former medical students (did I mention this was July?) were treating the monitor instead of the patient, a patient died. And the patient they were treating had some pretty bad burns and broken ribs.

Use your judgement. Sometimes, the monitor can alert you to the beginnings of badness before anything else will alert you. Other times, the monitor's malfunction will send you careening down the wrong path. According to Samuel Shem in "House of God," the first pulse to check in a code is your own. Maybe you like that expression better.

I know I shouldn't laugh at this but.... HAHAHAHAHAHA! :)

Holy cow.

[Tenebrae, BSN, RN]

Well no duh!!! Of course if your patient looks horrid and the monitor doesn't reflect that you should most definitely perk up and do some investigating.

Im regretting this post!

Your assessment skills can fail you just as badly as a monitor can, we have to use ALL THE DATA at our disposal.

Dont regret the post. Its created some good discussion

I work mainly in the community. And I've had several situations that really taught me the importance of using all the data avaliable and not taking one reading in isolation from the bigger clinical picture..

Patient A's blood sugar was showing severe hypo, yet they were alert and chatting and completely asymptomatic. When I rechecked with a different monitor BSL was within normal ranges

Patient B was showing all the symptoms of a CVA, they were diabetic however their monitor showed their BSL was within normal ranges. When the ambulance came they rechecked with a different monitor and it showed that the patients BSL was dangerously low. After several lots of IV dex and 2 lots of oral glucose the patient was almost back to normal.

[kakamegamama]

If there was ever a "wake up call", I think this is it......

[Elvish, BSN, DNP, RN, NP]

I think this is the classic case of a family that argues over each other before realizing that everyone essentially agrees.

OF COURSE monitors can be good. But if I started bagging every newborn baby whose pulse was 74 via pulse ox I would a) be wasting a lot of equipment and b) hurting a lot of babies. Because the baby's pulse is actually 148 (perfectly fine for a newborn) but because the pulse oximeter is a machine that picks up a certain wave amplitude as a pulse, and newborn radial pulses (where we measure preductal sats) aren't always at an amplitude that the oximeter can read unless your placement is perfect all the time. A newborn who's pink, alert, and has excellent tone is unlikely to actually have a pulse of 74.

If we freaked out and sectioned every patient whose FHR apparently drops to the 70s on the EFM (continuous EFM being another discussion altogther), we'd be wasting a lot of money and cutting a lot of people for no reason. Because a lot of times that pulse in the 70s is mom's pulse, not baby's.

I'd say I treat the patient and not the monitor way more often than the other way around.

I worked with a cardiologist in Central America who could listen to a heart and diagnose the patient exactly. The echo was essentially to confirm what he already knew. He's been a cardiologist for 50+ years and spent 30+ years working in the developing world, so he has seen plenty of stuff. He manages and treats people who should not be walking around alive, and he does it mostly without monitors. He is from that old breed of clinicians who rely on their five senses to do the majority of diagnosing. I would trust him with my life or any of my kids' lives every day of the week.