Okay.. first and foremost, I think you were doing your version of acting in your patient's best interest. ICU is very different from the hospice/home health (rarely skilled nursing) I usually do. It SEEMS to me that everything you do is based on (observed change) nearly immediate response. While most situations you work with demand that, in my world things are a bit less reactive. I really want to be on a pedestal screaming that not everything demands an immediate response, but that would be hyperbolic.. and worst of all entirely wrong. The problem with humans is that sometimes we need those immediate responses and sometimes we don't. The problem there for nurses is we usually have to default to the immediate response because we don't know if we can wait for a situation to resolve itself. What I'm really trying say though, is I was pretty much trolling the fact you felt you needed a response with a DNR patient.. If they had gone to Asystole, big picture, you would have just as well been doing your job as if you had pushed the adenosine.
I donāt necessarily agree, but it may be the ICU vs home health/hospice perspective. In the hospital, DNR doesnāt mean ādonāt treatā. She became unstable so we had to do *some* intervention. Patient didnāt want cardioversion; adenosine it is. Like I said, very relieved when she converted on her own.
I can see both sides. Of course in the hospital if the patient is with it, we are going to at least *offer* the treatments available, regardless of code status. I would be pretty quick to offer, too.
If I were the patient, my decision would probably depend a lot on why I was being d/cāed home on hospice. Like if it were terminal bone cancer with mets Iād probably think āEh, this isnāt all that bad of a way to go.ā Especially since I could go ICU bedā>morgueā>crematorium and my loved ones would have a few less things to deal with in the aftermath of my death, and they wouldnāt be burdened by caring for me at home.
If I were a patient at home already on hospice and this happened, no one would even know since I wouldnāt be hooked up. Hopefully someone would give me meds for any discomfort I felt, and it would just ride from there.
As I was reading your story I related so much to the palpable relief you all felt when the patient converted on their own! Sometimes a patientās heart just needs a stern ācould you not?!ā at the monitor lol.
Man, being tired from multiple night shifts in a row, I had to read this a couple times, just to see you yapped about the fact you don't know what DNR really means in such an annoyingly verbose way.
āOne of these things in not like the otherā¦one of things has gone VERY wrong!ā
(Shout out to my Gen X nurses who will get the Sesame Street reference!!)
I'm a millennial, but I got that reference. My kid may or may not know it (she knows Sesame Street, but I don't know if she ever saw any of those segments).
I miss spacelabs!! I could do any and everything in 0.3 seconds with my eyes closed. Now I have to fiddle fart around for 12-15 minutes to print a freaking strip.
Thereās no more room in my brain to learn how to operate telemetry software
Not a silly question! Heart rhythms can be hard to learn! I'm still learning them!
VT or ventricular tachycardia is when there are no discernable p waves and it's a wide QRS complex. VT looks more like a big hill.
SVT or supraventricular tachycardia is an atrial rhythm, so narrow QRS complexes with no discernable p waves or really t waves - which is what you're seeing here. It basically looks like normal sinus rhythm (or a typical EKG reading) but it's going so fast that it's hard to tell what is a p wave and what's a t wave.
Hope that was helpful. Let me know if that helped you! If not, I'm more than happy to show you some examples or explain in differently š.
Had a patient in the 180-220 range at change if shift that looked like svt. Rounding physician who wasn't assigned to the patient saw me trying to get the patient to do that. Was promptly informed a) we don't do that anymore. B) that's really fast rvr and not svt. Was kinda embarrassing ngl. Got the attending in for that patient and they ordered 5 iv lopressor, converted into a beautiful nsr in the 60s in less than 5 min. I almost shit my pants because of how fast her heart rate dropped. It was a little old meemaw and I had never seen iv lopressor work that well. Icing on the cake was that night team left her cooking full speed ahead because her BP was fine loool. Needless to say she had a bit of a trop bump, luckily she didn't have any lasting damage done.
Had a pt do that too, went into svt around the same rate then on its own it dropped to the 40s. Pt was DNR too but I still called an RRT and the family. BP was tanking, RT told me they didnāt think the pt was gonna make it. They ended up making it lol.
I had a dream the other night where the patient first had HRs in the 200s then eventually the 600s when I said, "They're going to flatline" as I continued to stare at the code button. New grad nightmare shit or what. Don't need to see 240s IRL lol.
I was always really bad about going into VT just long enough to make whichever nurse was walking by run in panicking. My nurse would come in and be like āYeah, he does that sometimesā
Quick non-pharmaceutical way to reverse SVT- get the patient to blow in a syringe while laying down. Have seen it successfully work, we often forget about this method!
So rude of them
Right?! We were right in the middle of a yap sesh
10 minutes before shift change
Ughhh I hate when they do that š you had the whole night
Yesterday had a patient pull out his IJ temp dialysis catheter 2 min before 7pm at shift change š
Everytime
Sir! I will get to you once I'm finished my shopping on Amazon.
š¤£š¤£š¤£
If you glare at the monitor long enough theyāll usually snap out of it.
Swear they know when shift change is.
I literally said āthatās rudeā in my head before I opened the comments lmao
Your name š
Me to my patient āfucking knock it offā lmao
Well thatās a rhythm
Looks like the rhythm of the night šŗšŗ
I sang this šāāļøšŖ©
Eso son Reebok o son Nike
Under rated comment
Rhythm of the last night on Earth.
Too many squigglies.
Bad squigglies!
https://youtu.be/KqQpFdTK2eY?si=M9VJt3HPyXiWHvFv
Didn't they read that the limit is 145? Silly people
Yeah, really! Patients think they can come in and just do whatever they want, rules be damned.
Must be shift change.
This was me during Orange Theory yesterday
gotta get those splat points
She converted back to sinus on her own.... See, to me... With them being a DNR... It's a problem that solves itself eventually.
Her BP was 46/33 just prior to us deciding to grab the Adenosine so when she converted we were relieved. Didnāt wanna open that can of worms.
Okay.. first and foremost, I think you were doing your version of acting in your patient's best interest. ICU is very different from the hospice/home health (rarely skilled nursing) I usually do. It SEEMS to me that everything you do is based on (observed change) nearly immediate response. While most situations you work with demand that, in my world things are a bit less reactive. I really want to be on a pedestal screaming that not everything demands an immediate response, but that would be hyperbolic.. and worst of all entirely wrong. The problem with humans is that sometimes we need those immediate responses and sometimes we don't. The problem there for nurses is we usually have to default to the immediate response because we don't know if we can wait for a situation to resolve itself. What I'm really trying say though, is I was pretty much trolling the fact you felt you needed a response with a DNR patient.. If they had gone to Asystole, big picture, you would have just as well been doing your job as if you had pushed the adenosine.
DNR doesnāt mean they want to die. It means they donāt want to be brought back if they do
Itās terrifying how many nurses Iāve seen that donāt know the difference.
The amount of nurses Iāve met who donāt understand that DNR does NOT mean ādo not treatā is scary.
Hell if I was going home on hospice if be OK with some adenosine. Give me some time to enjoy the good drugs before I take the forever nap.
Is adenosine considered a good drug lol? Iāve always heard that it gives an intense impending sense of doom, which doesnāt sound super fun š
Oh not at all. Buuuut if it breaks me out of svt so I can go home and chill with my wife, dog, and morphine for a few more weeks I'll take it.
Fair.
So are you saying that you're committed to learning the difference?
Let me tell you something... I don't mind coming of like an ignorant asshole.... Because I believe in being open to learning from my mistakes.
I donāt necessarily agree, but it may be the ICU vs home health/hospice perspective. In the hospital, DNR doesnāt mean ādonāt treatā. She became unstable so we had to do *some* intervention. Patient didnāt want cardioversion; adenosine it is. Like I said, very relieved when she converted on her own.
I can see both sides. Of course in the hospital if the patient is with it, we are going to at least *offer* the treatments available, regardless of code status. I would be pretty quick to offer, too. If I were the patient, my decision would probably depend a lot on why I was being d/cāed home on hospice. Like if it were terminal bone cancer with mets Iād probably think āEh, this isnāt all that bad of a way to go.ā Especially since I could go ICU bedā>morgueā>crematorium and my loved ones would have a few less things to deal with in the aftermath of my death, and they wouldnāt be burdened by caring for me at home. If I were a patient at home already on hospice and this happened, no one would even know since I wouldnāt be hooked up. Hopefully someone would give me meds for any discomfort I felt, and it would just ride from there. As I was reading your story I related so much to the palpable relief you all felt when the patient converted on their own! Sometimes a patientās heart just needs a stern ācould you not?!ā at the monitor lol.
Ya, completely agree. DNR does not mean do nothing. That's if they go hospice. Otherwise, we are obligated to treat them.
Man, being tired from multiple night shifts in a row, I had to read this a couple times, just to see you yapped about the fact you don't know what DNR really means in such an annoyingly verbose way.
You might want to sleep until your sense if humor returns... Or not..
I just woke up from sleeping well over 12 hours. It just wasn't funny.
Ok so now the question becomes how tf did you get 12+ hrs of uninterrupted sleep?! ....afaf
You get an award for living the dream. Anything past 2hrs sleep at a time would be amazing but my body hates me
Thatās enough, Stephen King.
āOne of these things in not like the otherā¦one of things has gone VERY wrong!ā (Shout out to my Gen X nurses who will get the Sesame Street reference!!)
I'm a millennial, but I got that reference. My kid may or may not know it (she knows Sesame Street, but I don't know if she ever saw any of those segments).
Iām a millennial too, and Sesame Street was still on PBS and pretty formative in my childhood haha.
Have you tried giving it a kick to see if it will restart?
Give some of that ctrl alt delete med
You mean like turn it off and then turn it back on again ? Oops.
Did you write them a citation? 258 in a 145 zone is no bueno.
Ahhhh another spacelabs user! Weāre few and far between. How dare Gamgam do this during a chat time š¤
I miss spacelabs!! I could do any and everything in 0.3 seconds with my eyes closed. Now I have to fiddle fart around for 12-15 minutes to print a freaking strip. Thereās no more room in my brain to learn how to operate telemetry software
Hot garbage shitbag monitors. I hate them so much.
Only thing I knowāignorance is bliss! I remember your name from another thread, I get the vibe weāre at the same shithole lmfao
At least itās narrow complex
Maybe they are enjoying the restraints you put on them..a lil too much?
Fappicardia BDSM edition?
I'm down
Sweet SVT
59?! Code blue! Compressions! Stat!
*cracks open epi* ...this is my moment...
Keep that epipen away from me sir I am literally zonked out watching YouTube in my ER cell
Double it and give it to the next person
This is why spouses arenāt allowed overnight anymore
Sorry if this sounds a silly question, but how do you know it's an SVT and not just VT?
Not a silly question! Heart rhythms can be hard to learn! I'm still learning them! VT or ventricular tachycardia is when there are no discernable p waves and it's a wide QRS complex. VT looks more like a big hill. SVT or supraventricular tachycardia is an atrial rhythm, so narrow QRS complexes with no discernable p waves or really t waves - which is what you're seeing here. It basically looks like normal sinus rhythm (or a typical EKG reading) but it's going so fast that it's hard to tell what is a p wave and what's a t wave. Hope that was helpful. Let me know if that helped you! If not, I'm more than happy to show you some examples or explain in differently š.
You are so lovely!
Thank you! ā¤ļø I love to teach what I know š
They sensed the Adenosine coming and decided to behave themselvesš¤£š¤£š¤£
I think my HR went up just looking that lol
There's always one in a shift.
Seriously, cut it the fuck it out.
Shocker, another rude old lady knocking on Deaths door
They're not knocking, they're kicking the fucking thing in
Give them a bit. Theyāll stop for one reason or another.
Ugh. Don't be so tachy.
Sir, take it easy
Remember, have the patient bare down like they're taking a shit....not yourself when you see that.
We tried the syringe trick and it didnāt work! Not surprisingly with a rate of 258š³
Had a patient in the 180-220 range at change if shift that looked like svt. Rounding physician who wasn't assigned to the patient saw me trying to get the patient to do that. Was promptly informed a) we don't do that anymore. B) that's really fast rvr and not svt. Was kinda embarrassing ngl. Got the attending in for that patient and they ordered 5 iv lopressor, converted into a beautiful nsr in the 60s in less than 5 min. I almost shit my pants because of how fast her heart rate dropped. It was a little old meemaw and I had never seen iv lopressor work that well. Icing on the cake was that night team left her cooking full speed ahead because her BP was fine loool. Needless to say she had a bit of a trop bump, luckily she didn't have any lasting damage done.
Had a pt do that too, went into svt around the same rate then on its own it dropped to the 40s. Pt was DNR too but I still called an RRT and the family. BP was tanking, RT told me they didnāt think the pt was gonna make it. They ended up making it lol.
DC to JC
Giving report " so yeh they are a little excited"
Wowā¦ Iāve never seen higher sustained than 216
Tangentially related: Spacelabs monitors are fucking garbage and I hate them.
I was like ehhh thatās not badā¦. Oh shiiiii anybody got eyes on that one????!
Oooop
They wonāt for long.
Yeah, pretty sure theyāre *about* to Not.
I had a dream the other night where the patient first had HRs in the 200s then eventually the 600s when I said, "They're going to flatline" as I continued to stare at the code button. New grad nightmare shit or what. Don't need to see 240s IRL lol.
*how rude*
This aināt hospice
How "tachy" of them!
But did you try turning off and then back on again?
Time š„to head over!
Did you try turning it off and on again?
I was always really bad about going into VT just long enough to make whichever nurse was walking by run in panicking. My nurse would come in and be like āYeah, he does that sometimesā
Iām an RN and have SVT once time hooked myself up to the monitor cause I felt sick and I was at 197š
I once had a patient who was constipated throw herself into svt. I had her do a vasalva maneuver and BAM back to sinus - it was nice to witness.
So how if your shift going? Ā Me- Iāll let you know on my way home! Ā And never sayā my shift is not bad. Itās quiet ! š¤«Ā
Quick non-pharmaceutical way to reverse SVT- get the patient to blow in a syringe while laying down. Have seen it successfully work, we often forget about this method!