Nursestories

Posted on January 24 , 2010

Triage instinct – part 2 rss

On Sunday evening, around 19h15, a forty something year old man shows up in triage by ambulance because he had some sort of weakness during the morning. He’s an American Indian who came from up North, escorted to the hospital because of a medical appointment he had to attend the next day. During my physical evaluation the patient didn’t show any signs of distress and didn’t complain of any symptoms. After the paramedic gave me her report she handed me and EKG strip in which she didn’t seem to know what it meant, but for me it seemed at first glance quite alarming, except it didn’t fit the patient’s asymptomatic state.

According to the patient, he’d sometimes have those episodes of weakness related to a drop of blood pressure. In fact, his BP on arrival was 93/57. Still, it was an element easily adjustable with some IV hydration. Everything led me to believe that he could be coded a 3 in the waiting room. But because he had a history of diabetes, CRF with dialysis, HTN, and bilat. legs amputations, I felt he could be at risk for something serious. I therefore did an EKG, thinking that depending on the result I’d be able to assign him at the right place.

The first reading told me that it was impossible to diagnose and that there was a defect on the reading. That wasn’t good enough for me. I needed a real result, so I did another one and finally it told me that the patient was in V. Tach. I showed it to a doctor and he told me there was also some ischemia and he needed to be treated right away.

I brought him to the acute care unit as close as possible to the nursing station and showed the EKG to the doctor there. He told me that he’s probably hyperkalemic because of his wide QRS wave and if we don’t do anything he could crash in the next 7-8 minutes. Right away, 5 nurses intervened, each doing their part, in the calm with great communication. It was beautiful to watch.

I later learned that the patient’s K+ was 8.4 which is extremely high considering that the normal is b/w 3.5-5.0. I didn’t realize the importance of my intervention until the doctor and nurses came up to me to congratulate me on my good decision making. They told me I had just saved this man’s life. That’s a huge statement, because it makes you realize the level of responsibility that we have to deal on a daily basis. I was a bit emotional after wards. Not cry-cry emotional but lightheaded emotional. It actually felt good to know that I actually have enough skills to do good in this business.

Posted by: RN13 1 comments