Jump to content

What would you have done?

Posted

Specializes in Med-surg, NICU.

I was doing an admission this morning in a home. She was discharged from hospital yesterday after only being there for 24 hours for a syncope episode. They did a big work up and never determined the cause. At the start of my admission she started saying she was dizzy while sitting at the table with me. She asked me to hand her the trash because she was a little nauseous. I took her blood pressure and it was 95/48. I get her a thermus of water and tell her to drink. We continued along and probably 20 min later she complained she was really dizzy and was having a hard time keeping her head up. I took her BP again and this time it was 59/32. So im like yikes a 40 point drop almost and shes symptomatic. So I tell her and her son who is present that she needs medical attention. I take it again a minute later and this time it is 55/28. Shes 85 and weighs 100 lbs and has a wheel chair and lives 5 min from hospital. What would you have done... Let her large son and grown granddaughter drive her to ER, or call for an ambulance and remain with the patient?

Call EMS/911 without a doubt!

I would have called for an ambulance. What was the outcome in this situation?

Agree that I would have called for an ambulance.

chicago_RN

Specializes in Med-surg, NICU.

Ugh Im an idiot. I was concerned with a BP so low that she would be unsafe to transfer but with the three of us we got her in her wheelchair no problem. I suggested at least twice to call an ambulance but the patient insisted she just needed to get there. When I called report to the ER the triage nurse couldn't believe I let her go by private car. I hate that I got flustered and obviously made a mistake. Not sure of the outcome yet.

I would have called EMS. Then again, you can't force her to go in ambulance.

KelRN215, BSN, RN

Specializes in Pedi. Has 10 years experience.

Ambulance.

Farawyn

Has 25 years experience.

You know the answer by now.

Is she okay?

MizChelleRN

Specializes in diabetic education, dialysis. Has 12 years experience.

Agree 911 should have been called but honestly she was probably seen way faster the way it actually happened.

BostonFNP, APRN

Specializes in Adult Internal Medicine. Has 9 years experience.

Did you lay her down?

Sent from my iPhone.

ktwlpn, LPN, RN

Specializes in Med Surg, Homecare, Hospice.

. When I called report to the ER the triage nurse couldn't believe I let her go by private car..

What were you supposed to do,sit on her?

chicago_RN

Specializes in Med-surg, NICU.

I did get an update and when she got to the hospital her BP was 113/70 something. I gave her water to drink on her way to the hospital but how did it go up that much?? I know what I heard.. Anyways, they kept her overnight seeing as she had that syncope episode two days prior. Weird..

michlynn, BSN, RN

Specializes in Cardiology. Has 2 years experience.

Called for an ambulance without a doubt! If that had happened at the hospital that would have been a RRT for sure, pt is completely unstable at that point.

ambulance- they could start iv access and get orders for meds faster

OP- First off, you are not an idiot!

I would've called 911 for an ambulance as well. It sounds like you knew in your gut 911 would've been the best decision but you left the decision in the hands of the patient rather than calling right away.

It is not easy being alone in someone's home with their family members all around, not having other nurses right there to help you and bounce ideas off of. Sounds like a good learning experience for you and all of us reading this to follow our intuition and err on the side of caution for the patient's safety. Best of luck to you! :)

NurseSpeedy, ADN, LPN, RN

Has 18 years experience.

If the patient and their family refuse an ambulance the ambulance will not transport them. As nurses, we urge them to use EMS, we advise them of the pros of EMS and the cons of not calling them, but we cannot force them to go. Yes, they live only five minutes away, but the quickly dropping BP and exactly how low she was and symptomatic, the transport could of (but thankfully did not) result in a cardiac arrest in transit which is why an ambulance would be best. Also, if the patient were to lay down with feet elevated this could help raise the BP prior to the medics arriving, so that if she were to be getting worse it buys some time for the medics to arrive. But, once again, the patient/POA has the final say. I have a family member who went to the ER twice with syncope, sent home the first time, stayed overnight because her daughter asked them to observe her overnight, ended up needing major surgery. Often times the reason for the episode is an underlying health condition that has gone unnoticed.

MrChicagoRN, RN

Specializes in Leadership, Psych, HomeCare, Amb. Care. Has 30 years experience.

OP,

you did the best you could, and the family/patient refused. This should be clearly documented.

There can be many reasons why they didn't want the ambulance: sometimes its its a matter of pride, independence, money, or even dreading the prospect of one more ambulance ride. But what if something happened in the drive over?

I think the best option would be to say, "Your BP is unstable, and I highly recommend you go to the hospital by ambulance...(and this is why)...You can refuse if you choose, but this is what I recommend." Then call 911 & they can either leave before the ambulance gets there, refuse when it arrives, or say..."ok, I guess you're right."

This way, you clearly did all you could do. The rest is up to the patient.

mc3, ASN, RN

Has 12 years experience.

Called an ambulance. Period. What if she was being transported by her family and they were stuck in a traffic jam? Then what?

mc3:cat: