Hi guys,
Thought I would get my post for this week (#2) up. I guess this goes along with a common theme recently - clinical experience (something I am sure we are all learning and getting better with).
I had a patient today who was admitted for an exacerbation of COPD?, however the Drs also query the possibility of an MI. (This individual has previously experienced cardiac problems). While going for our first walk together on the ward (no contraindications according to medical staff), his heart rate was up to no good - in as far as me trying to interpret it! It was extremely erratic - from 90 - right up to 175, to 110 to 145, to 80 etc.....Now I am sure we have all experienced some glitches with our oximeters, so I at first attributed it to that - tried different fingers, a diff oximeter, palpation.... Now the only problem with palpation is that it is a little more difficult to do during amb - hard to get all that accurate. At rest, his heart rate seemed to stabilize (and palpation was obviously easier). Now this was a bit disconcerting to me as heart complications/incident may have been the reason for his admission. However, I did continue on with the ambulation but paid close attention to other signs such as facial expression, color, perspiration, breathing rate/pattern, posture and of course his sats. We experienced no problems and he may actually be for D/C tomorrow.
Now, I think what I did was ok and these pracs are supposed to start to teach us to use clinical judgement but like Claire had mentioned - at what point is experience enough/are we qualified to make these judgements. I don't know yet? Like I said, I feel comfortable with that, but who knows right (I guess that is something you could ask yourself about a lot of things though..). So, to put it out there - what would you have done? A) once discovering this aberrant HR, return to bed ASAP B) Do as I did C) Other.
PS - nobody had much to say about this abnormal HR. Pt mentioned later on he had experienced this before - no adverse complications.....
Cheers and good luck with the rest of the week,
Donelle
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1 comment:
Hi Donelle,
If your patient had a suspected MI prior to admission he would have had specific markers that would have lked the doctors to believe that it was an AMI, ie inc troponin, CK, or elevation of ST wave on ecg. you should be able to access these blood levels and see the trend of elevation or depression on the computer systems. (I know we have access to them).
This information is useful to us becasue we are then able to create a mental base on the capabilites of the patient, on how severe the MI was. However this information is useless when you are currently ambulating a patient, so then it goes back to symptomatic behaviour and personal judgement.
When I walk our post AVR and CABG patients I do not trust the portable oximiters at all (ok granted they are hooked up to a telemetry system) but palpation and being aware of the patietns symptomatic behaviour of an erratic HR (+/- fibrillation) will help you guide your Rx.
I would have done exactly the same as you. monitor their face, colour, speech, chest pain, breathing and posture patterns, and continued with the Rx.
Ryan
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