So here's the scenerio:
I get a patient at 1900, the report was right sided weakness and slurred speech from 1100-1500. Symptoms have since resolved. BP is 114/60. I rush him to CT and neurology says its most likely a TIA, will admit to the stroke unit for observation. We get back to the ER, the patient also mentions he has had a cough for a couple days. Chest x-ray is ordered, hes got a touch of pneumonia.
2100: BP is 112/59 and IV antibiotics are going in at 250 ml/hr.
2200: Admit orders come through with the second antibiotic ordered at 250 ml/hr and maintence fluids at 40 ml/hr.
2230: BP 102/55. I think "Ahh poop I still need to hang fluids. Well we're super short on pump channels and he's getting much more than that from the antibiotics, I'll come back to it." Pt is still AAOx3, no neurological deficits.
2300: Code comes in. Being a team player, and loving a good code, I jump in to help.
0000: I'm supposed to be leaving now, but the code just came in and I have to clean up my patients. Neurology calls me.
Neuro: "I've been trying to call you for an hour!?!"
Me: "I'm sorry, a code just came in. Whats going on?"
Neuro: "Why is the patients blood pressure so low?? Why haven't his fluids been hung?! This is unacceptable! He could have had a stroke! Bolus him with 250, hang the fluids, get a new bp and call me back when the bolus is done!!"
So first I start to freak out. Did I do something way wrong? I'm still pretty new to this nursey thing, and I'm super anxious about making sure I don't do anything to cause harm to my patients.
But then I start thinking and getting angry. His blood pressure dropped 10 points since arrival, which is completely normal. Neurology saw this patient twice, and internal medicine evaluated him. No one was concerned about his blood pressure. His fluids were ordered at 40/hr, so because of me he didn't get 120 mL's from when the order was placed until neurology called. He did, however, get 750 mLs from the IV antibiotics.
At this point I'm getting angry, because of the way he was talking to me and for what he was accusing me of. (Plus, my shift was over, and I felt like I needed to clean this up before leaving.)
When I get angry I shut down. My face turns bright biohazard red. My eyes well up. My hands shake. My voice cracks. I'm not sad or upset, I'm angry, but people can't tell the difference and it's so frustrating. I don't want to cry. I'm not upset because someone yelled at me. I'm ANGRY.
So I'm trying to fix this (and leave for the night) and people keep coming up to me "Whats wrong?? Are you okay??" Yes. I am. Leave me alone. NOW.
I infuse the bolus in 15 mins and hang the fluids. Recheck the pressure and (shockingly) it's the same. I call neurology. "Well how long ago did the bolus end??" Uh. Just now. I did exactly what you asked me to do. He makes no changes to the orders but insists that I travel with the patient to the half hour MRI he just ordered because "the blood pressure is unstable." NO ITS NOT! It dropped 10 points since arrival! This guy is fine! And then he said "Once the MRI comes back, if it's negative, I don't really care about the blood pressure."
I'm fuming, and I cant find anyone to give report to.
Finally, one of the murses who is precepting said he would take it. I can barely get through report because I'm shaking and trying not to cry.
I clocked out at 0130, got in my car and finally the tears started flowing. Not sad tears, angry tears.
You may read this and think I was completely wrong, and maybe I was. But if the doctors felt it important for him to get fluids, I would expect an order > 40 mL/hr. If it was at 150, I probably would have searched for the part I needed and hung them. I was angry that they all knew what his blood pressure was on arrival, they had been down to check on him, and that this 10 mmHg change was enough for them to yell at me. I work hard and I do the best for my patients. The condesention in his call threw me into third gear. I can't work when I get like that. My mind gets all foggy, I don't talk to my coworkers, and everyone knows something is wrong. I hate that I have such a dead giveaway.
The patient ended up being fine, I got home around 0215, to wake up at 1000 and do it all again the next day.
TL;DR: I look like a lil bitch when I get pissed.
-K
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