Monday, April 4, 2011
So "Stat" Means Do It Yourself
This post is a couple weeks late but I have composed many blogs in my head and am just finally now getting the time to post them on our 10 hour flight back home.
I literally walked into the Women’s Ward this morning to find an 85yo acutely ill woman with pneumonia with a heart rate in the 200’s. (Normal being 60-100). Luckily she was stable though requiring oxygen, mentally just fine. Knowing the monitors are not always accurate I checked the woman’s pulse and listening to her heart. It was definitely atrial fibrillation (a.fib), an irregularly irregular rhythm and quite disturbing as it was so fast. I tried to understand what was going on, asking her nurse how long she had been in that rhythm and that I needed a stat EKG. The nurse said she didn’t think the monitor was correct overnight and that she had been rechecking with a pulse oximeter which read high 90’s. I tried to explain that a pulse oximeter is a brief moment in time, not as accurate as a monitor but to be sure the best test is to feel the woman’s pulse. I think she understood and we examined the patient together and she agreed the patient’s pulse was abnormally fast. But alas, no EKG yet. We called to find out what was taking so long and were told all the EKG techs were at chapel and not available. I said...where is the machine located, I’ll do it myself. So I went and got the machine, ran it myself and then determined that yes we need some IV medications to slow this heart rate. Well, supposedly they didn’t have IV beta-blocker or calcium channel blockers in Kijabe Hospital, hum. I walked over to the ICU to find out how one corrects this problem here as surely this was not the first patient with atrial fibrillation. No attending docs were available. I knew my other option was to shock her back into a normal rhythm but I didn’t think that could possibly be the best option for an 85yo woman who at this point in time was stable, though I wasn’t sure how long she would stay that way with a heart rate that fast. Randomly, an ICU nurse overheard my questioning and said they have some IV heart medications in the theatre (OR). So I headed down there to find what I needed. Long story short, IV labetalol was available (only option), I gave it, corrected the situation and the patient did well. But what a round about way of doing it. It was good practice for a similar situation a few days later. That one was a little more complicated because the patient wasn’t already on a cardiac monitor and I had to wheel her bed into the more acute monitoring room myself. I guess “stat” means....do it yourself. Reflecting on these situations, Dr. Mhyre (a supervising doc) teases the nurses saying, “Dr. Katy is going to pull out all of her hair....how much does Martin (my counterpart) have to pay to get some assistance?”
---Katy
Subscribe to:
Post Comments (Atom)
No comments:
Post a Comment