UGH. So I had this post written a month ago, and me with my clumsy fingers deleted the words and it autosaved nothing. So I'm going to try to recreate what I had. Forgive me if I'm missing bits.
The report I got from the nursing home paperwork said my patient was AAOx3, spanish speaking, but pretty much independent, only needed assistance transferring. He was sent to the ED for "lethargy, vomitx1 with dark brown emesis."
The patient I had in the stretcher would only open his eyes to loud verbal/tactile stimuli. We used the translator phone services to get information from him, but he was unable to form cohesive sentences. There were dark brown specks on his gown. Immediately I think GI bleed, so I drop B/L 16Gs in the ACs (like a boss). However, his SpO2 was barely breaking 90ish on 4L O2 via NC.
The resident and attending were not impressed with his presentation. His basic labs came back pretty normal, but after all that time, he was no more responsive and they wanted to admit him to a med-surg floor.
I kept insisting that something was wrong, that we were missing something. This guy was, at baseline, normally functioning, and now he was barely awake enough to speak a full sentence.
Finally, the internal medicine resident comes down to evaluate him, agrees with me that we're missing something, and orders an ABG. His Co2 was waaaay elevated! He orders bi-pap and consults critical care.
I was so frustrated. We could have saved so many steps if the doctors had just listened to me! Ive been an ER nurse for 2 years, and I don't feel as confidant as the seasoned nurses are, but I feel like I should have pushed harder. I knew something was wrong with this patient, and when all the labs came back normal I should have pushed to keep digging. Yes, this is the doctors responsibility, but I still felt partly responsible. No harm came to the patient, but now I know for next time. I have more experience than I give myself credit for and I need to trust my instincts.
On the other hand, docs, if your nurse is concerned about something...fricking listen!I may be young, but if I'm concerned about something, give me the benefit of the doubt.
TL;DR: Don't doubt when your nursey senses start tingling!
(also don't accidentally delete a post that was written two weeks ago...sorry if there are pieces missing!!)
-K
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