Wednesday, June 4, 2008

Sorry to interrupt, doc...

I had a patient the other day who's heart rate was running in the low 40s and occasionally high 30s. I went to inform the doctor.

"well, is he symptomatic?"
"um, no, not really, but I thought you might want to be aware"
"I'll tell you what, Braden, when he becomes symptomatic, come back and let me know."

Okay then. I can just see how this conversation would go:

"Hey Dr. Dude, your chest pain patient in room 12 just died. Apparently his heart rate was dangerously low with no known history of significant bradycardia, but his blood pressure didn't seem to be too bad to me, so I didn't bother letting you be aware of the situation."
"Oh, that's okay Braden, because he wasn't symptomatic until right before he died. Oh, and by the way, did you catch the baseball game last night?"

Perhaps I over-dramatize just a bit. This gentleman really wasn't showing any signs except for some mild shortness of breath that he came in with. I'm still learning all the ins and outs of ER nursing, and one of the tricky battles is when to bother the doctor with a piece of information, but it seems to me that while it may be frivolous to let him know about a heart rate of 56 (unless it had been 120 a minute ago), perhaps it would be good information to know that a patient is flirting with the 30s.

Call me crazy, but after we had a 28 year old "anxiety patient" die suddenly of a PE a few weeks ago, I would rather ere on the side of caution in letting the doctor know of unusual vital signs.

Am I wrong?


Carolyn said...

Those smelly doctors. They go to med school for like a million years and they think they're gods or something. Sheesh! Hey, as a patient, I'd be happy if you'd ere on the side of caution. Thank you very much.

Prisca: said...

oh man...

i feel like screaming every time i hear "is she symptomatic?"

geez, what are they waiting for??? my docs love to push things until the last minute, imho.

haha, love the smelly docs comment!

RehabNurse said...


About PE guy...if he had a fever, sweats and/or tanking O2 sats with that anxiety, nag the hell out of the doc. Just say spiral CT of thorax, please.

I almost lost a guy like this earlier this year. Everyone thought it was okay that he suddenly needed O2 after he was decannulated and his sats dropped(he had not used O2 except PRN for almost a week before).

Thank goodness our weekend doc believed me when I told her something was WRONG with him. It took several hours to get all the tests done, but he did live to get to that next birthday.

I don't know how much longer he lived past it (mom took him out AMA on a heparin drip), but he made it because one MD took this new nurse's word for it.

Braden said...

Rehab: Thanks for the comment. I actually wasn't there when the patient came in, but I heard the situation was just bad all around. Stories like that and yours are just constant reminders that while the "doings" of nursing (giving meds, turning patients, helping with procedures, etc) are important, assessing is the most important skill - even more so in a non-ER setting where you don't have immediate access to a doctor.

Tracey said...

I work in a CCU and I cannot tell you how many times we get a pt in on a Fri with a HR in the mid 20's to mid 30's and we are going to "keep our eye on them" until Mon when they can get their pacer. And you can guess who the "we" that is going to keep their beady little eyes on them are!!

We also ALWAYS hear "are they symptomatic" and I always want to answer "NOT YET!!!!!" Most of the time they are fine but I'm always reminded of the one that wasn't by Sat night at midnight.