The other night I was getting report from the say nurse on a post-pacemaker placement patient (try saying that 5 times fast!) who was all in a tizzy. Scattered and doing things that really didn’t make a whole lot of sense. It had been a busy day, but it seemed like she was making more work for herself than she needed. Almost like running in circles. Not productive at all.
When the excreted fecal matter hits the proverbial air oscillator, I make sure I take a moment to assess the situation. Following the and then begin to gather the situational information. It seems that the ability to do this was lost upon my colleague and she went from zero to “Holy Shit!” in about 30 milliseconds. Over what? A simple 5 beat run of V-Tach. , I check my pulse
Yes, V-Tach is bad. We all know V-Tach is bad. 5 beats though? Self-limiting in a patient who just come back from getting a pacemaker? With a slightly low potassium? Not all that surprising. But no, flew off the handle she did. Called for labs, called the doc and worked herself into the fore-mentioned tizzy, Through this the patient is fine. Happily chatting with his wife about this or that. He’s on the monitor, already has a K-rider infusing and is about as content as one can be in the hospital. Why the drama?
Because all to often people don’t think before they act. Had the nurse been thinking things through and not reacting several things should have gone through her mind. First, the ventricular ectopy in the form of multiple PVCs and a single run of VT was caused by two different things, the hypokalemia – the patient was 3.6 on the AM labs and the fact that the cardiologist has just been poking and prodding and electrified piece of wire inside this dude’s right ventricle. Or in other words they had been pissing it off. Second, she already was correcting the hypokalemia with the running rider and if she really wanted a magnesium level, a quick add to blood still in lab would have sufficed. Third, she needed to look at the patient. Vitals OK? Feeling OK? No chest pain or discomfort? Yes, yes and no were the answers. Simple isn’t it?
I think why this got under my skin so badly was that the nurses isn’t exactly new. She’s been a nurse far longer than I and has been in cardiology for nearly the entire time: she should know better. But it seems that my day shift has been functioning in the fight or flight mode for so long that any little issue, real or imagined, gets turned into a full-scale shit storm. It’s like when the LOLs with delirium are extra hyper-alert that the slightest thing sets them off. So it is with the day shift. They forget to think. Unfortunately many nurses are in the same boat, we’re running scared and rile ourselves up faster to make sure Bad Things© don’t happen. So stop, think, then act.
As for the pacer dude, well, things worked out just fine. All that drama for nothing.
hmmm…drama for nothing and chest pain free… h/t Dire Straits