Thursday, July 29, 2010

Nurses and their patients vs. doctors

Today, I had a patient who was trending downward, oxygen saturation in her blood plasma way lower than the ideal percentage of >90%. I called the doctor repeatedly, indicating my concern for her work of breathing, for her downward spiral, for her fatigue and stress, for the coarse crackles, and later, gurgling, in her lungs.

Without placing a stethoscope on her, he determined that she had atelectasis, gas and liquids in her peritoneal cavity, as a result of surgery, a benign finding, not her lungs. He ordered, at my request, a chest xray.

Well, low and behold, she had fluid on her lungs. Well, we diuresed her, we gave her packed red blood cells, which probably contributed to the problem, and I continued to harangue the hell out of the doctor for more orders, more aggressive treatment. Nope.

Finally, the patient was stating that she was exhausted, that she felt 'like you're going to lose me...' I reassured her, told her we would never let that happen, and unleashed my concern on the doc.

Stat chest xray... Hmmm, lungs full of liquid. Patient spiraling downward. Re-intubation and transfer to ICU.

Could we not have just avoided this by listening to the critical care nurse at bedside for 6+ hours? By being proactive instead of obstructionistic?

No, I guess not... I don't have an MD after my name...

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