This was, interesting

[SeaCat]

we got a patient in this morning. A younger male who was admitted to my unit through the E.R.

He came up to my unit and was a bit lethargic from the pain medications he had received. He wasn't very communicative when we checked him over although he did react when I pressed against his chest. It hurt, although the X-Rays didn't show any fractures in his ribs.

I did his vital signs and duly reported them to the R.N., but I didn't like them. The Blood Pressure didn't look right even though it was well within norms. I told the R.N. this and she just told me to do my job, she was the R.N.

I went to the Nurses Station and looked over the pass along chart, paying attention to the Vital Signs they had recorded. I didn't like what I was seeing. The spread between his Diastolic and Systolic Pressures was different. Now this isn't usualy a big deal but I was remembering a lesson I had learned way back when in E.M.T. Class, but had never seen.

I went back to the patient and took his Blood Pressure again, manually. I had to interupt the R.N. doing her admissions paperwork to do this and she wasn't happy. I recorded my readings and left. I did this three more times ten minutes apart. When I looked at my readings I saw a pattern and informed the R.N. about this. The guys Diastolic and Systolic Pressures were slowly coming together. Not by much, just by a couple of Millimeters Mercury each time. Once again the R.N. blew me off. I was informed that she was an R.N. and had the training while I did not.

When I left the room cursing to myself in Geman I almost ran into the M.D. and the Unit Charge Nurse. The Charge Nurse knowing me asked me what the problem was. I told her the patient was, in my opinion, in trouble and showed her why I thought so. She admitted she didn't understand what I was showing her but showed the M.D. who promptly freaked out.

Within minutes the patient was loaded onto a stretcher and transported to CT. The R.N. was pissed and was filing an incident report about my going over her head when the M.D. called the unit. The patient was in emergency surgery. He told the Charge Nurse that the patient was going to be okay but had been very close to being dead.

So tomorrow my boss will be receiving two Incident Reports. One from the R.N. for going over her head and beyond my job skills set, and the other from the M.D. claiming that my insistance and attention to detail saved a patients life. It shall be interesting to hear what my boss has to say about this.

Cat

 

[SlickTony]

So what turned out to be wrong with him?

 

[TE999]

I have no doubt there are any number of competent and intelligent nurses who administer to their patients properly and effectively.

That being said, the hospital in which you work must employ the bottom 1/3 of nursing school graduates with the most inflated opinions of their medical abilities.

Kudos to you for saving that man's life. That nurse should be dismissed, but prolly won't be.

 

[SeaCat]

So what turned out to be wrong with him?

A little thing called Cardiac Tamponad.

It's not very common but I remember hearing about it and for some reason it has always stuck in my mind.

It's caused by a strike to the chest that causes a tear in one of the Cardiac Blood Vessels. (In this case a small one.)

What happens then is the blood escapes into the sac of tissue surrounding the Heart. (The Cardiac Pleura) As this blood seeps into the sac it fills it causing the heart to be compressed. If enough blood seeps into the sac it will compress the heart enough where it can no longer beat effectivly. One of the major signs of this is the Systolic and Diastolic Blood Pressures coming together. In this case the pressures were coming together very slowly as the leak was a small one.

Cat

 

[rgraham666]

Good on you, Cat.

I didn't recognize the clinical term but soon as you said "Tear in one of the cardiac blood vessels" I went "Oh shit."

Again, good on you.

 

[SeaCat]

I have no doubt there are any number of competent and intelligent nurses who administer to their patients properly and effectively.

That being said, the hospital in which you work must employ the bottom 1/3 of nursing school graduates with the most inflated opinions of their medical abilities.

Kudos to you for saving that man's life. That nurse should be dismissed, but prolly won't be.

In partial defense of this R.N., who is technicaly a very good Oncology R.N. this was a very slowly evolving problem. It was also a problem one usually sees in Accident Victims and not fight victims.

Usually this problem has a rapid development. It is also fairly rare.

On the other hand she didn't listen and was very adamant about not listening.

Then again knowing most of my fellow Aides I don't have to wonder why.

Cat

 

[SlickTony]

It was also a problem one usually sees in Accident Victims and not fight victims.

Why is that?

 

[SeaCat]

Why is that?

It's usually seen in people who have gone through a head-on car accident without the benifit of a seat belt. They move forward and slam their chest into the steering wheel column.

The force it takes to cause this kind of injury is considerable. About the only way a person can get this kind of injury in a fight is a kick directly into the chest, at just the right angle.

Cat

 

[SlickTony]

Well, yeah, a kick to the chest can crack the sternum. Seems to me that might be hard enough to result in cardiac tamponade.

 

[SeaCat]

Well, yeah, a kick to the chest can crack the sternum. Seems to me that might be hard enough to result in cardiac tamponade.

Not really. It's the amount of force directed into the heart itself. A lot of the force is disipated by the chest and the bony structure surrounding it.

The force has to travel in a line through the heart and be strong enough to damage the vessels. This usually involves the person moving forward. Usually when this happens the injury os large enough to cause fairly rapid bleeding into the Cardiac Pleura.

In this patients case there might have been a weakness in one of the vessels that ruptured due to the impact.

Usually an impact like this will cause bruising of the Cardiac or heart muscle with produces other problems. Like I said this kind of injury is fairly rare.

Cat

 

[Vermilion]

Never tempted to pursue further training Cat? Or is it one of those things where the higher up you go, the less you have to do with the patients which is the bit you enjoy, anyway (kinda like in teaching)?

Just curious
x
V

 

[Selena_Kitt]

Good call!

 

[carrie-on]

I recognized it as soon as you mentioned the Systolic and Diastolic coming close together, If this man was moving towards the other one and the other kicked him at the same time, it could result, the forces are incredible and the heart muscle can only take so much. Good for you, for catching it. Any luck on getting into nursing school, yet?

 

[christabelll]

Good For you SeaCat....
??? wasn't this what killed Lady Diana?

 

[Selena_Kitt]

Good For you SeaCat....
??? wasn't this what killed Lady Diana?

Was it really??

 

[epiphany65]

Never tempted to pursue further training Cat? Or is it one of those things where the higher up you go, the less you have to do with the patients which is the bit you enjoy, anyway (kinda like in teaching)?

Just curious
x
V

I think this is a great idea, Cat. I don't know what your status is now because I'm not familiar with nursing in Fla., but if you're a CNA or LPN, it shouldn't be too difficult to become an RN... should it?

 

[neonlyte]

Kudos, Cat. Keep up the good observations.

 

[Starscream_UK]

Does the Peter Principle apply to the RN then??? You know, you rise to the level of your own incompetence...in which case, I'm sorry to say, you may stay at the bottom of the ladder for a looooong time...

As others have said, well done for spotting it.

 

[SimonBrooke]

Y'know, I read this thread and had deja vu...

Last time I was hinging round the hangout you had similarly hair-raising tails of A&E. I saw this story and wondered if it had somehow floated up from two years back... I have nothing but respect for people who work in A&E, it's vital job for which you receive too little reward and far too few thanks.

 

[Corylea]

Good for you! I hope your boss draws the correct conclusion from the two incident reports -- make sure to tell us the rest of the story!

And I know who I want taking care of me if I ever have something weird wrong with me.

 

[kromen]

Kudos to you for being a true professional.

 

[Lee Chambers]

I personally think that they should have Cat training every new person who comes onto the staff. And give him a big whacking stick too.

"This is Cat. This is Cat's stick. Cat is going to explain how to do your job right. The stick is for when you decide to be a jackass."

 

[Corylea]

I personally think that they should have Cat training every new person who comes onto the staff. And give him a big whacking stick too.

"This is Cat. This is Cat's stick. Cat is going to explain how to do your job right. The stick is for when you decide to be a jackass."

Second the motion!

 

[SeaCat]

LOLOL

Well my wife and I are both looking at getting back into school to get our R.N.'s. We are saving money with this in mind. There are a couple of things holding us back though.

1) Money. School costs a lot and we make too much for most assistance. (I refuse to take out a loan because of what happened the last time I took a school loan.) The corporation we work for does have an assistance program of sorts but they only reimburse you $1200 a year. (That might cover your books.)

2) Availability of classes. The number of openings in Nursing Schools are limited due to the low number of people willing to teach. (Last year the schools in my area turned away well over 1000 qualified applicants because they didn't have enough instructors.

2a) Demographics. There are certain people given preference due to politics within the system. Neither my wife nor I qualify for these preferences.

3) Time. Because we both work wwe are limited to the times we can take classes. This limits us on the programs we can reasonably apply to.

One of these days my wife and I will get into a Nursing Program and get our R.N.'s.

Cat

 

[SeaCat]

Well the Boss received the two incident reports today. She called me into her office and started chewing me out about stepping beyond my training/status. I shrugged and asked her if the patient had survived and she told me he had but that didn't matter. I asked her why this didn't matter and she changed the subject.

She brought up one of my patients that had fallen on Saturday. She claimed the patient now had a Pelvic Fracture and this was entirely my fault, because the patient had fallen while under my care. I had been expecting to hear about this as well and was at least partialy ready. (I hadn't expected the Pelvic Fracture part.)

I explained the situation, how the patient had goten up without notifying us of her need to get up and had then fallen. (Night Shift had forgotten to turn on her Bed Alarm.) I had found the patient on the floor and initiated the proper procedures. The Charge Nurse had ordered proper follow up which included CT Scans of both her head and pelvis.

I then asked how they had found the Pelvic Fracture as the CT of her Pelvis had come back negative. She argued with me about this until I grabbed the patients chart and showed her the report. There it was in black and white, no deformaty or signs of injury other than scarring due to an old Pelvic Fracture.

She then told me I was lucky, and sent me on my way, (She had misread the report.) with the warning not to step beyond my accepted skills set. This was about what I expected. Nothing will be said about the night shift forgetting to turn on the bed alarm and nothing will be said about the R.N. not catching the problem.

Ah well, I feel good about what I did and that's truly all that matters to me right now.

Cat