The power of observation

This week I would like to relate to a patient I have beeen seeing on a cardio-thoracic surgery ward. The 67 yo patient has had a CABG X 3 and on initial Ax in the am on Day 1 post-op in ICU he had minimal pain but was very drowsy and was unable to concentrate for more than 10 seconds as to what I was saying. I however followed the suggested protocol and was able to march him on the spot for 2 min and SOOB for SMI' s and a supported cough.



Later on he was tranferred to the ward where we were to see him in the pm and ambulate him with the support of a trolley for the attachments. On checking the obs charts he seemed stable and afebrile with the last entry but on observing the patient he seemed restless and had a short shallow breathing pattern. He was also tachycardic and had no BS in the R lower zones . He was not drowsy and able to converse as normally expected. He was very keen to go for a walk with me and could transfer independently which was very good for this stage in his recovery. I reported back to the senior physio as to my findings and she was immediately certain that some thing was just not right. We reported to the Dr who immediately called for a X ray which revealed a pneumothorax. We did not go for a walk that pm.



Reflecting back the patient did not seem to have CI to ambulating as other patients have been ambulated with tachycardia and SOB and he seemed very mobile at the time. On subjective examination and the most recent nursing obs the patient was clear to be treated but with a thorough objective examination some factors put together showed that something was wrong.



I guess while we are on a learning curve it is very important not to cut corners with any S or O examinations and always seek advice if not sure of something or just to be sure that it is safe to progress with your intended Rx.