What would you have done?

Specialties Home Health

Published

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?

Specializes in Cardiology.

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.

Specializes in PCCN.

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! :)

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.

Specializes in Leadership, Psych, HomeCare, Amb. Care.

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.

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:

Ambulance !!! For sure.

I would have called 911 and told the family and patient I was doing so. I'd do what I could to convince them to wait but if they left, the outcome would be on them.

If they stayed and waited, the patient could still refuse and the ambulance team could not force her to do so. Again, the outcome if she refused would be on her.

It is fair to state to the patient that you NEED to call 911 and the reasons WHY (beyond the severe and symptomatic hypotension). I would have simply stated that at the current decline in blood pressure, the patient could die as a consequence or suffer organ damage from lack of perfusion. If the patient required resuscitative life saving measures, the EMS could provide those measures. Otherwise, the patient isn't going to get treatment in a car. As always, when a patient (and their family) declines reasonable treatment, DOCUMENT, DOCUMENT, DOCUMENT. You can't force someone in an ambulance. But what you don't want is for someone to point out the possibility that the patient was not in a position to make a sound judgment about their own care.

Call for an ambulance without a doubt...

Specializes in HH, Peds, Rehab, Clinical.

Your patient pretty much refused your offer of an ambulance--which is her right to do. I wouldn't beat myself up over it.

A five minute trip isn't going to allow for much fluid replenishment via IV or other interventions. [

QUOTE=chicago_RN;8362109]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.

Great response.

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