What's your best catch?

[beekee]

I was reading another post called what was your worst mistake? I find reading about mistakes very informative and educational, but we never get kudos for all the good stuff we do. We just get lambasted (sometimes by others, often by ourselves). So, I want hear about your best "I rock" stories!

I don't have any great stories, but I'll share one recent encounter. I had a CHF patient who became fluid overloaded and went into respiratory distress. Doctor ordered P.O. lasix instead of IV. I took the time to double check that the doctor had indeed wanted PO (he didn't). I was a little hesitant to bother the doctor again, but he had a reputation of belittling staff. But, I did it anyway and he thanked me for calling (and changed the order).

[hawaiicarl, BSN, RN]

My wife, she almost got away!

Cheers

[beekee]

Too many of them to list.

Retroperitoneal hematomas, spinal ischemia on paralyzed patient, incarcerated wall scrotal hernia (I had to auscultate scrotum for that and the patient asked, in astonishment "but what did you listen for down THERE? ), innumerable DVTs. Right now eagerly waiting for neurologist to come and evaluate the patient for another zebra.

I just love zebras. And I love doing physical exams with no gloves. And, no, I do not have CT scan implanted into my fingertips.

Ummm...what does a "normal" scrotum sound like and what does a incarcerated wall scrotal hernia sound like?

[KatieMI, BSN, MSN, RN]

Normal scrotum is silent.

Patient (male) who complain on pain, first colics, then constant and increasing on the one side of abdomen low quadrant, sometimes radiating to groin, WBCs up, may be fever, abdomen remains soft and nice, can continue to have bowel sounds and even stool, U/A negative, u/s (if done) negative. In this situation, bowel sounds over scrotum are highly suspicious for direct incarcerated hernia.

Females - same thing, lateral femoral hernia, but way rarer.

[Have Nurse, ADN, RN]

My "Best Catch", was catching a pending abdominal aneurysm while assessing bowel sounds. Off to Surgery we go!!! (I was a new grad L.P.N. at the time.)

[Have Nurse, ADN, RN]

Ummm...what does a "normal" scrotum sound like and what does a incarcerated wall scrotal hernia sound like?

Better you than me. LOL

[Have Nurse, ADN, RN]

Quote from KatieMI

Too many of them to list.

Retroperitoneal hematomas, spinal ischemia on paralyzed patient, incarcerated wall scrotal hernia (I had to auscultate scrotum for that and the patient asked, in astonishment "but what did you listen for down THERE? ), innumerable DVTs. Right now eagerly waiting for neurologist to come and evaluate the patient for another zebra.

I just love zebras. And I love doing physical exams with no gloves. And, no, I do not have CT scan implanted into my fingertips.

Better you than me.

[TigraRN]

Have Nurse, was it bruit that you heard?

KatieMI - I am impressed, and need to learn to use my stethoscope more than I do.

[Coffee Nurse, BSN, RN]

Normal scrotum is silent.

There's a joke in there somewhere...

[wondern, ASN]

I can hardly wait for the drawing!

BTW, what's a zebra?

[smf0903]

I can hardly wait for the drawing!

BTW, what's a zebra?

I've always heard it as you hear the hooves, sounds like a horse, assume it's a horse. When you actually turn around and investigate, low and behold it's a zebra.

My best catch was during psych clinicals. We had to do full med cards, and I was assigned 2 patients, one was pretty much catatonic (and had been for like a week, no one knew why). Anyhow, while doing my med cards I notice that the aforementioned patient had two meds that seemed weird to have together-one was an agonist and the other an antagonist for the same neurotransmitter. It was the first thing I asked about in clinicals the next day. The instructor promptly called the physician, who discontinued the one med. within like 2 days the patient was back to their normal. Seems they had originally gone to the ED and a physician there had added one of the meds, no one had caught it.

[inthecosmos, BSN, MSN, RN, APRN]

As a relatively new grad still on orientation, I had a 28 year-old patient on tons of chemo. He wasn't responding to treatment and with a heavy heart, his mother had to make her baby a DNR. He was minimally responsive, would only take his medication when he heard the sound of her voice. He was never in good shape, our meeting was one of great sadness. I remember the day she made him a DNR. The CNAs, eager to give this man a bath and "finish their jobs," rushed in and demanded we move so they could do their jobs. The mother was tearful and desperately needed a moment before they began. We had just put the DNR bracelet on.

I asked the CNAs for a moment, which initially irritated them. They made excuses about what they needed to complete, but wasn't budging. I gave them a look and stated we would need a moment and they could come back in 5 minutes. I stood there with the mother, who was questioning whether or not she had made the right decision. We discussed his status and I reassured her. She asked me to pray with her, I obliged.

Sometimes, it's hard to remember we aren't just task mules.

[Wuzzie]

I've always heard it as you hear the hooves, sounds like a horse, assume it's a horse. When you actually turn around and investigate, low and behold it's a zebra.

The actual quote is..."If you hear hoofbeats, think horses not zebras". Coined in the 1940's by a Dr. Woodford. It was to teach his medical students to look for the ordinary first before looking for the extraordinary so as not to miss the easily treatable conditions. Somehow it's been turned around.

My "catch" happened to be a zebra. Obtunded, bradycardic, hypotensive, hypoglycemic and intermittently apneic toddler. First thought always goes to sepsis or abuse but something wasn't right. Little guy had been with grandma. Something triggered my brain to ask her what meds she's on. Turns out she let him play in her purse and her Metoprolol was in it. Lid was off and 5 pills missing. She knew he took them but didn't say anything because she thought everyone would be mad at her. All sorts of stupid going on there and darn it kids will freaking eat anything!!