Equiptment reliance
Hi all,
Always an eager poster, I hope this makes it into the correct weeks post. Ok so I am on a cardio prac at a large inner city hospital. My pt. has been admitted to my ward shortly following a decrease in BP and increase in SOB. The pt. is a "frequent flyer" as they say and has a long Hx of COPD with secretions. I flowed thru the S and O and was going great on my walk with her. The O2 levels were acceptable (89%) and she had no serious complaints of SOB but half way down the hallway her I noted her HR was dropping quickly (44 BPM!!). I had not done a BP check in supine and then in standing and had only gone on the nursing obs...being stable. Anyway I had also thought it best to ditch my watch so as to not risk scratching her skin. I was silently in a panic as there was ten meters to the nearest chair, no clock on the wall and no way to know if it was a misreading from the, often troublesome, sats meter. Anyway we calmly motored along and she was none the worst for it- with a quick return in HR once seated, but it made me conscious of the limitations of equipment, the need to palpate the pulse and to get a good idea yourself of the pts. orthostatic intolerance and general response to positional changes and exercise. Next time I will address all these. Cheers, Matt
posted by Matt @ 9:47 PM
4 Comments:
hey Matt,
I totally agree with you on the lack of equipment available on the cardio wards..it is so frustrating when you want to get someone up and walking safely, but you cannot find an oximeter if your life depended on it. Then you are in a tight spot...you obviously do not want to leave them in bed becuase of the benefits of ambulation, but then you don't want to risk it and get them up, only for them to drop on you!! I guess in that case you do what you did, just observe the patient for any physical signs: stoped talking, SOB, sweaty...etc. And what i learn to be really helpful is having a plan in your head before getting the patient up: say "we are going to walk to the door today" and then make sure you have a chair set up at the door. And then monitor their response, if they are doing well then go a bit further..and so on.
Like Tam I also agree. Firstly organization and initial plan is the key. Ensure you have a chair/s stratgically set up just in case. Have you sats monitor with you but at the same time don't totally rely on it. I think from memory anything less that sp02 80% it becomes inaccurate. Monitor vital signs is so important, like Tam mentioned find out how they are feeling, measure there pulse, colour, SOB, sweating, dizziness, nausea. Constantly gauge how they pt is feeling, and keep on talking to them ensuring the chance of something happening to be small. Keep on going Matt you seem like you are switched on.
Apologies for poor grammar and spelling Matt. I think I need to do a crash course in Spelling 101.
I found something similar on my cardio prac too. I needed to find some portable O2, and found a cylinder that had pressure and was still half full. Well that's what the regulator said.
Anyway, half way down the hall the patient had desaturated to 83% and was very dyspnoeic. I looked at the O2 cylinder and the thing was empty! A good reminder to double check all your equipment!
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