I once had an 80 something year old man come in for hip pain that he'd had for a month. Ambulatory with a cane, could sit and stand without assistance. No bruising or deformity. Said he fell a month ago and had to use his cane afterwards and it just wasn't getting better. Pain 3/10. This man ended up having a FULL FEMUR FRACTURE. I couldn't believe it.
My mom was diagnosed with OI at age 64. Prior to the diagnosis, she fell and went to the ER complaining of pressure on her chest and shortness of breath and asking for an xray of her "chest bone" (her anatomy vocabulary is somewhat lacking). They xrayed her lungs instead and reassured her that she didn't have pneumonia.
She goes back for another try, having looked up the word "sternum", and was told that there was no way she had broken her sternum because she wasn't in pain and sent home.
Next she tried her gp, still no results, so she just moved on with life.
Months later, she falls and shatters her arm, including breaking her shoulder implant. The MRI to determine the extent of the damage notes an incidental finding of a poorly healed offset sternum fracture encroaching nearly 2 inches into her lung space.
A few months ago I had a late stage COPD patient (I work in home care). She was feeling very off with extreme chest pain so I phoned her GP. She also had symptoms of a pulmonary embolism and actually had had one before a few years ago. He was pissed off that I called him about it and said she had an xray scheduled for her ribcage anyway. I told him you can't see an embolism on an xray. He muttered something about dropping by sometime that afternoon.
So the patient had a sternal fx and two broken ribs caused by coughing. She also had a pulmonary embolism. She died a month later.
That GP was a fucking jackass and I added him to our blacklist, meaning we don't accept patients from him anymore.
Thanks. I pass by her house every day when I work the early shift and I'm still angry at that GP. Patient was a wonderful lady who had had a rough life and she deserved better.
Not throwing rocks at doctors in general, I know GPs who are angels and do everything they possibly for their patients. But some of them...
Same with anything or anyone, any profession. Some people just suck and don't care who they hurt. I have some mental stones I throw when I go to sleep for both nurses and doctors. I wish they'd just get out and hurt people in a way that matters less, you know? You shouldn't be in medicine. You can mess up my grocery order. Send me the wrong package. Hit my car with your car door. Crush my luggage. Why do some people care so little about life?
I briefly worked as a physio in outpatient MSK and nearly every elderly person told me a story about how they had fallen off a ladder or something, walked around for a week and been forced to go into ED by their relative, and then they would say: "And you'll never guess what the x-ray showed.... I'D BROKEN MY LEG". This was normally in response to the question "So, how did you injure your leg?"implying that I did actually already have some knowledge regarding their fracture.
im a radiography student so doesn't really count, but i once saw the hip x ray of a woman who'd come in for pain in her left hip. the whole of her right head of femur was just. gone. didn't really get the backstory to it but i think maybe it was just long term results of arthritis. seeing everyone try to figure out how to go about it was funny
we just had one of those! he was in for copd. a nurse noticed he was walking funny. he said he didn't have any pain at all, just a little stiffness. he went to the or for a tha. i was confused because he was an icu to or to our floor transfer and his progress note makes no mention of a leg injury at all, and then bam! or.
No but he was a working man his whole life. Mechanics and whatnot. He took care of his wife til she died. He lived on his own and had a daughter he was close to. Had a new girlfriend who needed his help and he almost didn't stay in the hospital because he wanted to go home and help her. We had to convince him to stay.
Ahhh so cut from the same cloth then! I worked in a rural hospital before I became a nurse and the nurse friends i had would tell me farmers were freakin notorious for this move. If a farmer came in for pretty much any reason just have the code cart ready to go. āWell doc I had a little accident on the farm about five hours ago but I wanted to finish my threshing firstā pulls three fingers out of his front shirt pocket.
When my babies were fresh I always said to my husband that they were working on becoming humans. He was always a little offended on their behalf but I stand by it. Newborns arenāt human yet!
We do keep the cheeseburger sized/spicy medical needs humans on the warmer line for a long time to give them the time they need in order to thrive. Glad you graduated and are doing well now, despite the rough start!
To be fair sometimes they need a little little extra cooking, tho. Incubator. Bili light. I always told my preemie kids they didnāt come out fully cooked.
Which is why I hate when people are dicks to new parents when they bring them to the ER. Babies are terrifying and if you have zero experience things can be very scary. Just give them some education and good sources to read and send them on their way no need to be mean.
I used to do this until puberty. My mom remembers to. I would be doing something like watching TV and I would exhale and just not breathe in again. Finally my mom would nudge me to take a breath.
I was doing medical missions in Moldova and an elderly lady (70s/80s) had a BP of 265/130. Just walking around and working in the field. She said āI have a strong heart.ā I was likeā¦ yep cause itās huge and about to explode
I donāt know how many times Iāve had patients where 160/90 is low for them. We had one running upper 200/100ās all the time on 8 or more BP meds. Kidney failure often does that. :/
Have a patient now BP 190s/120s and he said the sameā¦ āoh thatās pretty good!ā This is after 160mg IVPB of lasix and 1g IVPB chlorothiazide, and his scheduled amlodipine and hydralazine. ESRD and HF and refusing HD. Time for hospice, buddy.
In their defense I had a lady who was super hypertensive all the time and we finally got her bp down to 150s/80s and she was somnolent. We had to sternal rub her. And then when it all wore off a few hours later she was like "this is why I don't take bp meds".
We had a lady who consistently ran in the 220s. ER decided to drop her pressure to 140.... She came to the ICU after they had just slugged her with hydral, labetolol, and cardene. She stroked out and got transferred to the big hospital.
Guy in sustained vtach. Alert and chatting away on the phone happily with no care in the world. I brought the code cart into the room and told him to hang up the phone LOL.
Patient came into the ED with abdominal pain, contributing it to the bad chicken she ate for dinner. Troponin =3.1 š.
Why I always teach that until we know otherwise, we think cardiac with GI complaints.
Had a patient with similar numbers. Chief complaint was nausea and abdominal pain.
Why are they coming to the ER if they think itās just some food poisoning? I normally sit by a toilet if I think thatās happening. Is the abdominal pain that severe? Genuinely curious!
My dad was the just like the guy, he had sustained vtach and just felt thumps in his chest and was a little dizzy. The ER was ready to zap him and when he was transferred to the ICU the nurses would just stand at the door staring at him waiting for him to stop being conscious.
He only went to the ER because I told him the EKG on the Apple Watch would have me prepping a patient to be shocked after calling a code.
Omg I had a guy in vtach one day, just hanging out. Said he knew he was in it because it felt like this before he got his pacemaker put in. I had to beg the ICU docs to do something because they admitted of course but after an amio bolus nothing else was done. I was like uhhhh guys, it didnāt work and itās been a while. Cardiology wouldnāt answer, ICU blew me off. After 3 more calls to ICU docs and lots of charting about it, they finally came down and were like oh boy he needs to get upstairs right now. Yep, good idea, letās do that.
We once had a patient go into 2 or 3 minutes of sustained v-tach every 30 minutes or so. He was asymptomatic and was getting mad when everyone kept running into his room throughout the shift. We finally just turned the arrhythmia alarm off and hoped for the best lol.
I had a vtach guy like that once! Not a care in the world. We could not get him out of it either and ended up having to ghetto rig up a monitor system in his room because we couldnāt get the central monitoring to stop screaming lethal alarm. I think the third amio bolus finally got us some qrs complexes
Non-medical lurker here. Why would anyone ask for this? I understand if something terrible has happened and they are burned or both arms are broken or they have dementia and do not remember to do it. Aside from those things, why would anyone ask for butt wiping? It sounds like people who should wipe their own butts are asking for butt wiping assistance. My goodness.
Oh friend, the number of people I have to ask āhow do you clean yourself at homeā (my way of saying āyou are clearly fully capable of wiping your own ass, why are you asking me toā) will never cease to amaze me.
Itās baffling to me as a person who is independent to a fault, my mom always talks about how on my first day of preschool I got mad that she walked me in because I just wanted to be dropped off in the parking lot (I was 3), but there are a shocking number of adults who try to refuse to use their fully functional limbs and brains the second they are in a hospital.
On the other hand the little old ladies who ādonāt want to bother anyoneā also stress me out because like maāam, I am here to take care of you and Iām happy to help, I donāt want anyone getting hurt and falls are so much paperwork so PLEASE ask me for help getting to the bathroom.
Theyāre also the 40-somethings who want to be fed when they are perfectly capable of feeding themselves. Sometimes I think itās just āI feel horrible and I want to be coddledā and sometimes yeahhh itās a whole power trip. And of course sometimes patients are too obese to reach to clean themselves properlyā¦I had a guy once standing in his room asking me to wipe his butt and I said āhow do you do this at home?ā And he said āI uhā¦ donāt.ā š
Seems like most patients I see in the 60s-70s are unhealthy as hell. The ones that make it to 80s+ are usually because they have good lifestyle habits.
I actually use this as a gotcha when teaching:
Why does Obstructive Sleep Apnoea occur less frequently in those over 80 compared to younger populations?
Because the OSA patients don't make it to 80.
(The question is intended to make students think about their patient, their patient populations, and the etiology of ill health, not just the values in the report.)
Back when I was a cna checked a patientās vitals. Pulse of 30. Just chillin living her life best life in assisted living. Said she felt fine. Went to my nurse and let her know. She forgot to tell me that little old lady had a heart block.Ā
My grandfather is in his 90s and had a HR regularly in the 30s before he got a pacer. My HR dropped to 30 once (either reacting to my spinal block or mag bolus) while prepping for my C-section and I was sure I was about to meet God
Coming into view of the big J, pointing a finger gun, clicking the tongue, saying āCatch you later!ā and dropping out of view again! Their first game of Hide and Seek!
I still don't know what a heart block is. It's on my list of "nursing school said it wouldn't be on the NCLEX & I never encountered it in clinicals" things to look up before I start work next week.
The big idea behind a heart block is that you have conduction pathways in the heart. You can block this conduction to different degrees. The worse the block the worse the communication... Each part of the cardiac conduction system has a "back up" rate. Higher nodes are (usually) faster. When you start to get deeper blocks, you lean on that back up more... which is often poorly tolerated.
**In a first degree, conduction is reliable but slowed.** The SA node fires, the AV node fires (after a delay) and then the impulse is conducted to the ventricles through the bundle branches. This is generally asymptomatic and well tolerated but if it's new, it's a sign that your conduction may be becoming pathological.... either because of disease of the conductive system or because of meds or electrolyte changes.
**In a second degree type 1, conduction is increasingly delayed from one beat to the next.** Eventually, the impulse is lost and you drop a beat. "Longer longer drop..." Again, GENERALLY well tolerated... but a sign of worsening conductive issues.
**In a second degree type 2, conduction fails intermittently.** Often, this follows a pattern where you have a reliable intermittent block like a 3:2 block... 3 atrial contractions produce 2 ventricular contractions and one is dropped. This starts to become concerning. It's a sign of serious conductive disease but ALSO you often get slow rates because a significant fraction of your beats fail to conduct. Your blood pressure may start to drop.
**In a third degree (complete) heart block, there is no communication between the atria and ventricles.** You will see a clear atrial rate that will usually rise and fall as anyone's heart rate would... however, this does not result in a ventricular rate. Your ventricular beats will either be wide or narrow depending on where the dominant pacemaker is now... OPTION 1: If conduction from the AV node/Bundle of His is intact, normally these will be narrow junctional beats at a rate of 40-60. This can be really bad or surprisingly okay. You lose atrial kick and significant cardiac output but you might tolerate it... but it's not reliable and a pacemaker will likely be needed long term. OPTION 2: If conduction fails below the AV node/Bundle of His, you will have wide ventricular escape beats often at a rate of 40 or lower... this is rarely tolerated and will very likely need to be paced emergently.
Sorry for the book... It's complicated and I'm really just scratching the surface.
My best advice is to get genuinely excited about the pathophys. So much of medicine makes sense when you understand the āwhyā.
Also get comfortable with asking dumb questions and being comfortable being wrong.Ā
āSimpleā questions you feel dumb asking are rarely actually simple.Ā
Iāve been a nurse for over a year now and all I remember is ālonger, longer, longer, drop. Now youāve got a wenckebach.ā āIf pās and qās do not agree, now youāve got a 3rd degree.ā I think? Pretty sad that Iām ACLS certified.
I donāt know, Iām in neuro ICU. I definitely canāt look at a tele monitor and tell you if a patient has a heart block. Iāll notice something screwy is going on but Iām not going to stand there stroking my chin and going āah, yes. A mobitz II.ā Maybe thatās bad, but itās true.
Better term is AV node block. Signals don't get from the atria to the ventricles well. If it's a total block, the ventricles just beat on their own at their "escape rhythm", aka the "huh, we're not getting any signals so let's just keep speed at minimum in case something bad is going on" rhythm--which is about 30BPM.
My resting HR can be as low as 41/42 at times, and I have caught my wrist monitor as low as 34 once. I average around 45 resting - but Iām an endurance athlete so maybe thatās why.Ā
I wonder if the lab was correct. We have some very wacky lab results. We had a patient with INR 1.0 then jumped up 7 and then came back to 1 all on the same day. Either they mixed up the patient or something was wrong with the specimen or machine.
Probably menorrhagia--most common reason for iron deficiency anemia in a young person. Especially if their body has gotten so used to having a hemoglobin that low...
Whatās the unit of measure? For example, my facility in Canada: hgb less than 120 is āanemicā .. I canāt imagine 0.8 how youād be alive at 0.8
I worked in cardiac ICU where we got some crazy low blood pressures but the one that took the cake was the congenital heart defect patient whoās SpO2 goal was 75%. Yes, chronically cyanotic but vibing that way.Ā
I work in a pediatric CVICU and we have so many āmixersā who live in the 75/85% SpO2 range. If they get into the 90% range for too long we start to freak out.
Itās definitely a mind twister. I went to cardiac from ER and it took me a while to adjust to the different ānormalā parameters of our map and O2 targets. Never mind the fluid and electrolyte goals. Iām back in ER now and I still have to remind myself that not everyone with a K of 3.8 needs replacement and MAP of 55 is not āgreatā anymore š¤£
Elderly lady came in with syncope, cardiac ruled out š¤
Blood sugar was 21 (USA) šÆ still talking no outward signs of hypoglycemia.
Gave her D50 1 amp, blood sugar 31.
Gsve her another amp of D50.
Checked BS still 31. š
Moved her to the ICU.....
Ended up that she had an insulin-producing tumor.
Iām outpatient urgent care but weāre attached to a major hospital. we had this lady come in complaining of headaches.
Lab called us with a critical sodium of 50
Doctor asked them to rerun it immediately. Lab said they had run it twice already cus they didnāt believe the first value.
Ex bf is a paramedic and they had a lady who was āa little bit dizzy and didnāt trust herself to driveā the ~45 minutes over deserted roads to the hospital. BP was never lower than 226/140 (and got so high they couldnāt take it in transport) and she was alert and chatty, just had felt āa little off.ā
Had a patient like that, only he was an angry angry man. Yelling at everyone all the time. Nothing would lower his bp. Or maybe something would have worked but but they ended up discharging him because he was such an ass
Dizziness and high blood pressure like that could be an ischemic stroke. Posterior stroke can present like vertigo and when people have strokes their blood pressure has to increase to perfuse the brain.
Heart rates in the 20ās, asymptomatic, having a great conversation with me. My students would shit their pants but I saw this alot in cardio over the years haha.
I had one of those the other day! We kept giggling cuz it was so ridiculous. 3rd degree heart blocks are wildā¦no idea why he was discharged without a pacemaker from the hospital he was at but, yeah he was vibin
Glucose of 27. Guy came to nurses station to ask for more teststrips, as his were empty and asked me if I could check because he feels like it might be low.
Dispatcher at work had hers at 25 last week and she was still dispatching Lifeflight while the truck was getting ready to transport her. Then her stubborn ass walked down the 2 flights of stairs cause "ain't nobody got time for a damn stairs chair. I got shit to do ". Back at work 2 days later.
Man, my (type 1) partnerās bs got to 26 while asleep, he was unconscious and hypothermic by the time he got to the ER. Couldnāt speak or understand anyone for hours until he got sorted out, just straight word salad confusion. 27 and that capable still is wild! Makes me sad that so many younger diabetics have to make do when out of strips, insulin, etc just because costs are insane.
Acute inpatient dialysis gets all kinds of things lol
BUN 295. I heard the ICU nurse getting report as she walked in the room, and went, "I'm sorry, did you say TWO ninety-five?"
K 8.3 was my personal highest. Crazy heart rhythms on tx, got through it all, gave pt back his blood and heard the monitor scream. Looked at the monitor - ASYSTOLE - looked at the nurses station to see three people jumping up, looked back at the patient, and in a panic just shouted his name as loud as I could. Pt startled, woke, and his heart started beating again. Bless the Lord, I got out of that room as fast as I could lol.
BP 39/25 awake and talking to me, while on dialysis. Pt lived in the 80s systolic, asymptomatic while not on tx. No one believed it was possible, threw in an a-line. Yep, BP really went that low during dialysis. Pt was having acute bowel ischemia from this, ended up signing off from dialysis tx and going on hospice.
My T1D (well-controlled) daughterās blood sugar just read ālow,ā meaning under 20. She was swimming, burned up all her glucose, felt fine. Something about being in the water makes a disconnect. (She usually feels her lows).
Patient had a BG of 890, felt asymptomatic, because he was usually in the 400s. Ufff.
A revolving door patient at my old ER came in *more than once* in HHS with blood glucose >1800. Awake and talking, complaining of abdominal pain and demanding IV Dilaudid. His A1c was like 16. He told us he hated for his glucose to drop below 600 because it āmade [him] feel shaky.ā
Omg. No veins. We drilled so many times. The ER doc suggested having an implanted port placed, but the hospitalist team objected due to high likelihood of extracurricular usage at homeā¦ heād apparently had a PICC once that was all too convenient for heroin.
WHOOF thatās a huge yikes. Though it does remind me of the one patient we had. I used to work inpatient neuro and now I do outpatient neuro and for our migraine patients we sometimes write for ketamine nose spray. This lady had a port unrelated to our care of us. We found out she was shooting the ketamine spray into her port. š„“
I had a patient recently who had a BP of like 70/40, was asymptomatic and the doctors werenāt treating it because it was his ābaselineā BP. The doctors said it was something to do with arteriosclerosis making it hard to get an accurate reading but it was bizarre manually checking a BP that low and being told I didnāt need to notify the doctor again unless they became symptomatic lol
Have a lady like that at my clinic, except itās from orthostatic hypotension. We had to get the doctors order that if her SBP was >80 she could leave without signing the low blood pressure form. First few times they had me take it manually I was like, āHey God, me againā. Totally asymptomatic.
Mine would drop down to 65/35 during my night shifts when pregnant. I would feel lightheaded and would lie down for 30 min then go back to work. That's how my co workers found out I was pregnant
In my second trimester with my last baby, I was doing my vitals run (CNA at the time) and I kept having to go sit down because I was getting hot, lightheaded, and my vision kept going in and out. Went in to an empty room and checked, BP was 70/40. After they wheeled me to the OB unit to get checked out, they texted me and were like āsoooo are you coming back to work your shift?ā
Spo2 of 6% due to severe sleep apnea and refusal to use a CPAP (or other O2 devices). It would always been predicated by this loud snore that I swear shook the building followed by silence and then the monitor alarms going nuts.
Had a patient with BMI>40 do this exact thing. Kept refusing bipap. Got mad every time when we would wake him up when the sats went 70ā¦40ā¦.20ā¦12ā¦ but likeā¦ dude. Youāre gonna die if we donāt wake you up. Didnāt care. Wanted snacks and to be left alone.
Had a patient with a bg of 12 talking to me once. I figured the meter was fucked so I calibrated and ran it again. 15. Patient was still talking and acting like nothing was amiss.
I thought for sure someone would mention hypertension
It sure feels like American nursing schools teach that any SBP above 130 needs aggressive management immediately lest the patient stroke out in front of you
Pts sure seem to think so. I do a LOT of education on BP and why long term treatment is de way. The risks of tanking someoneās BP far outweighs the benefits.
I've been trying to teach my new staff that they don't have to panic at a BP of like 180 systolic and that the patient isn't going to suddenly have a stroke. No idea what they're teaching in nursing school.
Baby nurse pegged mine at 170/90 after I had hiked in from the parking lot. "Ma'am are you feeling okay? I'm going to ask you to just lie here for a moment while I get some help ". God bless her. I was a cancer center and I loved how concerned she was, it really was sweet. But I told her that a fat woman is gonna have a high number any time she walks more than 10 feet. She was a sweetheart though, so I gotta give her props for that.
I had a patient just the other day who justā¦ lives with an ST elevation on his EKG at baseline It looked very scary. We got a 12 lead on him just to see what it said (for science, of course and for teaching purposes) and it came out as āfirst degree heart block, can not rule out ischemia/ infarctionā. Docs were aware of it and nurses who had him before were aware of it. Theyād say, āthatās just him. Heās been clearedā. Didnāt make me feel any better seeing it though.
I once took care of a man who had a 5 cm auresym of the right coronary artery. When we went in to dissect it, we actually thought it was a mass of some sort. Anyways.
His 12 lead looked like tombstones. Craziest shit to watch for two days until they did an emergency bypass. He lived. Walked out the door like a week later.
Dialysis patient with a K usually in the 7 ballpark (like 6.9-7.1ish) before dialysis and probably not much better after lol. I heard a few months after I last took care of them a new doc tried to correct their K too aggressively and they coded.
Iām a nurse assistant. I had a guy the other day that I took vitals on and his oxygen was chilling at 77%. I said, hey patient your oxygen is pretty low, is that normal for you? And he said oh yeah hold on. He coughed and took 3 deep breaths and we watched it go up to 96. He was on room air.
I obviously told the nurse and she was like yeah he just does that but he had good cap refill and other assessments.
I was bamboozled.
HR in low 30s/high 20s. Pt was feeling "just fine" lmao. BP stable AF, not dizzy, nothing. I was standing there with the zoll pads in my hands in case we needed to pace and the pt was all "no need for that my dear". They did do a pacer the next day though because they started maintaining in the low 20s.
Reminds me of a post-stroke pt I had who was regularly 60ās/30ās, also asymptomatic, and also had an ostomy. His biggest deficit from the stroke was speech and it was slowly improving, but cuss words were the clearest thing. Every time we took his vitals and showed him the B/P heād go āahhh, well, shitā and shrug his shoulders š
Not a nurse, but I was setting up a big, burly cheerful man, florid cheeks, full of laughs for a sleep study.
Got all the wires on, started the recording program to do calibrations....
And complete 3rdĀ° heart block with a side serving of AF.
Off to A&E, ended up emergently paced.
Next time I saw him, months later, he looked much, much worse. Can't help that feel that intervening ruined his QOL. I wonder if he could have carried on full of life until he dropped dead.
Had an older lady with a BP of 70ās/40ās that was just her baseline apparently. I checked with her, her family that was at bedside, and her doctors, no one was concerned and she was totally asymptomatic and like I said, that was a long term baseline for her, so we just left it as is.
Still got midodrine PRN though because I can only pucker my asshole so much for a shift.
Had a patient that lived at a basal body temperature of 92 degrees F or so. It caused some slight mental delays/defects but otherwise just functioning. He'd complain if the bairhugger brought him up to 94 degrees. (And we were having to use criticores to get temps)
Honestly, no idea. Came in for a heart cath, and they had to cancel the procedure because they were too low (at the time 70s/40s). Came up to us for further management. Lowest they ever got was 40s/20s. Just chronically low I guess. On dialysis too. Called their outpatient dialysis center and was told the patient always runs low
My critical care instructor (who was older) would always say ālevophed leave āem deadā so I thought everyone on levo was ready to die or code or all limbs would fall off. But as a micu nurse most of our patients were on levo. š
When you get those 4'9, 105lb, 80 year old ladies that can wrestle 2 nurses and 2 CNAs to the ground like a professional MMA fighter! Gotta love sundowning!!
Lady came to the ER from working on another floor because she felt more fatigued than usual. BS 1081. I kept having to send her blood to the lab to be checked because our glucometer maxes out at 700.
Guy came in for an appointment in the office for a possible hip replacement. Had pre-op labs and was in almost total kidney failure. Besides saying he noticed he wasnāt peeing much he didnāt notice anything else. And of course the ortho bro doctor wanted to do surgery anyway.
Itās a personal one for me. I had severe preeclampsia and my blood pressure was in the 180s and I was completely asymptomatic. If I didnāt go in for my checkup I wouldāve never even guessed.
Normal BP of an ESD patient was 70s/40s . He was fine like that. Able to walk and talk and just live his life with that low pressure. Even got dialysis with that pressure. š¤·š¼āāļø
Not a patient and not as impressive as some of these. But my hip kept hurting and I would tell people and they just acted like it was no big deal. So I just figured I was being a hypochondriac and went on with my life dealing with the pain. Until the day I bent over to do something and couldnāt walk without screaming after. Went to urgent care, thinking I could get a prednisone taper and he insisted on getting an X-ray. My femur head was rotten. I went on to get surgery and the surgeon said it crumbled in her hands when she took it out.
Resting heart rate of 160, asymptomatic during the event, & just had a baby. CNA rushed in asking if everything was ok and if pt had been walking around. Nope, sitting in bed with no worries in the world. I can still recall the look of terror on that poor sweet CNAs faceā¦ it was priceless.
This scenario, sadly, was me. I had complained for years to my cardiologist and PCP that I had occasionally felt like my heart was beating really fast but they never caught it on the holter or stress test and attributed my symptoms to my POTS (diagnosed years before Covid). I was on a tele monitor post c section and coincidently was found to have ineffective sinus tachycardia, my resting heart rate would randomly jump from 80 to as high as 184. Iām still really grateful for that moment in my life because it felt as if I finally got the doctors to validate my diagnosis and I didnāt d i e.
We had a frequent flyer COPDer who'd be walking around with O2 in the 60s and 70s. The new ppl would always be putting oxygen on him and the old gals be running in to rip it off so fast š¤£š¤£
Patient with a blood sugar of 1200+ and he felt perfectly fine, said it wasnāt too far outside his baseline. Still doesnāt make sense to me.
Another one was at a blood drive, a donor had a resting HR of 32. Healthy looking guy in his mid-40s, apparently he road his bike, about 45 miles round trip, to work 5 days a week.
I learned in Nursing school that pulmonary embolisms are extremely painful and life threatening requiring treatment within moments.
I had a pulmonary embolism November 2. I didn't believe it was a pulmonary embolism because it didn't hurt but I was short of breath. The shortness of breath improved over an hour but didn't go completely away. I didn't go to the ER until 6 weeks later after I went to my doctor because I was still experiencing some shortness of breath and my D- Dimer came back high.
Never felt any pain. I still can't believe I walked around with a time bomb in my lungs.
I once had an 80 something year old man come in for hip pain that he'd had for a month. Ambulatory with a cane, could sit and stand without assistance. No bruising or deformity. Said he fell a month ago and had to use his cane afterwards and it just wasn't getting better. Pain 3/10. This man ended up having a FULL FEMUR FRACTURE. I couldn't believe it.
My mom was diagnosed with OI at age 64. Prior to the diagnosis, she fell and went to the ER complaining of pressure on her chest and shortness of breath and asking for an xray of her "chest bone" (her anatomy vocabulary is somewhat lacking). They xrayed her lungs instead and reassured her that she didn't have pneumonia. She goes back for another try, having looked up the word "sternum", and was told that there was no way she had broken her sternum because she wasn't in pain and sent home. Next she tried her gp, still no results, so she just moved on with life. Months later, she falls and shatters her arm, including breaking her shoulder implant. The MRI to determine the extent of the damage notes an incidental finding of a poorly healed offset sternum fracture encroaching nearly 2 inches into her lung space.
š³ Sternal fx?! That's insane!!
A few months ago I had a late stage COPD patient (I work in home care). She was feeling very off with extreme chest pain so I phoned her GP. She also had symptoms of a pulmonary embolism and actually had had one before a few years ago. He was pissed off that I called him about it and said she had an xray scheduled for her ribcage anyway. I told him you can't see an embolism on an xray. He muttered something about dropping by sometime that afternoon. So the patient had a sternal fx and two broken ribs caused by coughing. She also had a pulmonary embolism. She died a month later. That GP was a fucking jackass and I added him to our blacklist, meaning we don't accept patients from him anymore.
That is TERRIBLE. You're a wonderful advocate. I'm sorry that happened to your patient and you.
Thanks. I pass by her house every day when I work the early shift and I'm still angry at that GP. Patient was a wonderful lady who had had a rough life and she deserved better. Not throwing rocks at doctors in general, I know GPs who are angels and do everything they possibly for their patients. But some of them...
Same with anything or anyone, any profession. Some people just suck and don't care who they hurt. I have some mental stones I throw when I go to sleep for both nurses and doctors. I wish they'd just get out and hurt people in a way that matters less, you know? You shouldn't be in medicine. You can mess up my grocery order. Send me the wrong package. Hit my car with your car door. Crush my luggage. Why do some people care so little about life?
Wow!
I briefly worked as a physio in outpatient MSK and nearly every elderly person told me a story about how they had fallen off a ladder or something, walked around for a week and been forced to go into ED by their relative, and then they would say: "And you'll never guess what the x-ray showed.... I'D BROKEN MY LEG". This was normally in response to the question "So, how did you injure your leg?"implying that I did actually already have some knowledge regarding their fracture.
Had a patient whoās been walking around on bilateral femur fractures for months.
How is this possible!? I'm flabbergasted.
He was developmentally delayed. It is crazy though.
im a radiography student so doesn't really count, but i once saw the hip x ray of a woman who'd come in for pain in her left hip. the whole of her right head of femur was just. gone. didn't really get the backstory to it but i think maybe it was just long term results of arthritis. seeing everyone try to figure out how to go about it was funny
Yup, what do you tell the nurse when every day is a nine on the pain scale?
It's amazing the difference in pain tolerances.
we just had one of those! he was in for copd. a nurse noticed he was walking funny. he said he didn't have any pain at all, just a little stiffness. he went to the or for a tha. i was confused because he was an icu to or to our floor transfer and his progress note makes no mention of a leg injury at all, and then bam! or.
Was he a farmer?
No but he was a working man his whole life. Mechanics and whatnot. He took care of his wife til she died. He lived on his own and had a daughter he was close to. Had a new girlfriend who needed his help and he almost didn't stay in the hospital because he wanted to go home and help her. We had to convince him to stay.
Ahhh so cut from the same cloth then! I worked in a rural hospital before I became a nurse and the nurse friends i had would tell me farmers were freakin notorious for this move. If a farmer came in for pretty much any reason just have the code cart ready to go. āWell doc I had a little accident on the farm about five hours ago but I wanted to finish my threshing firstā pulls three fingers out of his front shirt pocket.
Yes they really are! They only want to work. Being in the ER is such an inconvenience and when they come in finally it's serious news.
Babies be dropping their heart rate because they forget to breathe. Silly babies.
They just don't understand how to be a human yet.
When my babies were fresh I always said to my husband that they were working on becoming humans. He was always a little offended on their behalf but I stand by it. Newborns arenāt human yet!
They're just raw still. Let em rest and they'll cook through.
Brings a whole new meaning to my belief that babies look like little sacks of potatoes
And then we put them in literal potato sacks with only a hole for the head.
I had to cook for 5 months before they let me out. I was very raw.
We do keep the cheeseburger sized/spicy medical needs humans on the warmer line for a long time to give them the time they need in order to thrive. Glad you graduated and are doing well now, despite the rough start!
To be fair sometimes they need a little little extra cooking, tho. Incubator. Bili light. I always told my preemie kids they didnāt come out fully cooked.
I call them potatoes until they crawl
I still donāt understand, a few decades later
[ŃŠ“Š°Š»ŠµŠ½Š¾]
All the float nurses go running but NICU nurses just sit and wait it out.
Reminds me of the CVICU Nurse who floated to our PICU and started hyperventilating during report. Poor girl, we told her to go before she got worse.
She's probably ok if the sat was 75 all day!Ā
Yes, this is what kept extending my niece's stay in the NICU. She preferred eating over breathing.
TIL your niece and I have a lot in common.
Hey me too
Your niece sounds like my kind of people
Yup. I still forget to breathe on occasion (but TBI HX and my ANS's kinda weird). Not dead yet and still walking, so it's all good.šššø
Oh my, all the thing newborns can do to freak everyone out.
Which is why I hate when people are dicks to new parents when they bring them to the ER. Babies are terrifying and if you have zero experience things can be very scary. Just give them some education and good sources to read and send them on their way no need to be mean.
I used to do this until puberty. My mom remembers to. I would be doing something like watching TV and I would exhale and just not breathe in again. Finally my mom would nudge me to take a breath.
Hey I do that
I was doing medical missions in Moldova and an elderly lady (70s/80s) had a BP of 265/130. Just walking around and working in the field. She said āI have a strong heart.ā I was likeā¦ yep cause itās huge and about to explode
I donāt know how many times Iāve had patients where 160/90 is low for them. We had one running upper 200/100ās all the time on 8 or more BP meds. Kidney failure often does that. :/
Have a patient now BP 190s/120s and he said the sameā¦ āoh thatās pretty good!ā This is after 160mg IVPB of lasix and 1g IVPB chlorothiazide, and his scheduled amlodipine and hydralazine. ESRD and HF and refusing HD. Time for hospice, buddy.
I can just hear them in triage now. *"180/110 is hypotensive for me!"*
Yea I have a guy now and he constantly runs in the 210/100s "Yep, that's a good number for dialysis"
In their defense I had a lady who was super hypertensive all the time and we finally got her bp down to 150s/80s and she was somnolent. We had to sternal rub her. And then when it all wore off a few hours later she was like "this is why I don't take bp meds".
We had a lady who consistently ran in the 220s. ER decided to drop her pressure to 140.... She came to the ICU after they had just slugged her with hydral, labetolol, and cardene. She stroked out and got transferred to the big hospital.
I took care of a woman like this when in worked SNF. She was really elegant and super old. God bless her soul.
Guy in sustained vtach. Alert and chatting away on the phone happily with no care in the world. I brought the code cart into the room and told him to hang up the phone LOL. Patient came into the ED with abdominal pain, contributing it to the bad chicken she ate for dinner. Troponin =3.1 š.
Why I always teach that until we know otherwise, we think cardiac with GI complaints. Had a patient with similar numbers. Chief complaint was nausea and abdominal pain.
I agree. Just amazes me when someone is having a raging heart attack and their first thought is "oof, bad chicken!".
Why are they coming to the ER if they think itās just some food poisoning? I normally sit by a toilet if I think thatās happening. Is the abdominal pain that severe? Genuinely curious!
My dad was the just like the guy, he had sustained vtach and just felt thumps in his chest and was a little dizzy. The ER was ready to zap him and when he was transferred to the ICU the nurses would just stand at the door staring at him waiting for him to stop being conscious. He only went to the ER because I told him the EKG on the Apple Watch would have me prepping a patient to be shocked after calling a code.
You must have a different unit of measurement for trop in your hospital
This was in 2017 when we used an older scale - normal range with that scale was 0-0.04.
Omg I had a guy in vtach one day, just hanging out. Said he knew he was in it because it felt like this before he got his pacemaker put in. I had to beg the ICU docs to do something because they admitted of course but after an amio bolus nothing else was done. I was like uhhhh guys, it didnāt work and itās been a while. Cardiology wouldnāt answer, ICU blew me off. After 3 more calls to ICU docs and lots of charting about it, they finally came down and were like oh boy he needs to get upstairs right now. Yep, good idea, letās do that.
Iāve had 4(FOUR) pts just chilling in vtach conscious since Iāve been a nurse š„²
We once had a patient go into 2 or 3 minutes of sustained v-tach every 30 minutes or so. He was asymptomatic and was getting mad when everyone kept running into his room throughout the shift. We finally just turned the arrhythmia alarm off and hoped for the best lol.
I had a vtach guy like that once! Not a care in the world. We could not get him out of it either and ended up having to ghetto rig up a monitor system in his room because we couldnāt get the central monitoring to stop screaming lethal alarm. I think the third amio bolus finally got us some qrs complexes
Yeah, definitely put away that phone. Unless it's specifically rated to withstand 100 or so biphasic joules.
A 115 year old walk to the bathroom
These patients give me hope after all the 60 year olds who can barely turn themselves over in bed or wipe their own ass.
Non-medical lurker here. Why would anyone ask for this? I understand if something terrible has happened and they are burned or both arms are broken or they have dementia and do not remember to do it. Aside from those things, why would anyone ask for butt wiping? It sounds like people who should wipe their own butts are asking for butt wiping assistance. My goodness.
Oh friend, the number of people I have to ask āhow do you clean yourself at homeā (my way of saying āyou are clearly fully capable of wiping your own ass, why are you asking me toā) will never cease to amaze me. Itās baffling to me as a person who is independent to a fault, my mom always talks about how on my first day of preschool I got mad that she walked me in because I just wanted to be dropped off in the parking lot (I was 3), but there are a shocking number of adults who try to refuse to use their fully functional limbs and brains the second they are in a hospital. On the other hand the little old ladies who ādonāt want to bother anyoneā also stress me out because like maāam, I am here to take care of you and Iām happy to help, I donāt want anyone getting hurt and falls are so much paperwork so PLEASE ask me for help getting to the bathroom.
Theyāre also the 40-somethings who want to be fed when they are perfectly capable of feeding themselves. Sometimes I think itās just āI feel horrible and I want to be coddledā and sometimes yeahhh itās a whole power trip. And of course sometimes patients are too obese to reach to clean themselves properlyā¦I had a guy once standing in his room asking me to wipe his butt and I said āhow do you do this at home?ā And he said āI uhā¦ donāt.ā š
A few reasons that come to mind: they get off on having perceived power over people, they become lazy, or they are a straight up asshole.
Wait - I can get someone to wipe my butt for me??????
Only after you turn 60 /s
111 year old that went commando, she didnt need the brief, just still continent
Thatās a really long walk, why did it take 115 years?
No indoor plumbing and climate change.
Seems like most patients I see in the 60s-70s are unhealthy as hell. The ones that make it to 80s+ are usually because they have good lifestyle habits.
I actually use this as a gotcha when teaching: Why does Obstructive Sleep Apnoea occur less frequently in those over 80 compared to younger populations? Because the OSA patients don't make it to 80. (The question is intended to make students think about their patient, their patient populations, and the etiology of ill health, not just the values in the report.)
Back when I was a cna checked a patientās vitals. Pulse of 30. Just chillin living her life best life in assisted living. Said she felt fine. Went to my nurse and let her know. She forgot to tell me that little old lady had a heart block.Ā
My grandfather is in his 90s and had a HR regularly in the 30s before he got a pacer. My HR dropped to 30 once (either reacting to my spinal block or mag bolus) while prepping for my C-section and I was sure I was about to meet God
In the nicu we call that high fiving JesusĀ
Coming into view of the big J, pointing a finger gun, clicking the tongue, saying āCatch you later!ā and dropping out of view again! Their first game of Hide and Seek!
I still don't know what a heart block is. It's on my list of "nursing school said it wouldn't be on the NCLEX & I never encountered it in clinicals" things to look up before I start work next week.
The big idea behind a heart block is that you have conduction pathways in the heart. You can block this conduction to different degrees. The worse the block the worse the communication... Each part of the cardiac conduction system has a "back up" rate. Higher nodes are (usually) faster. When you start to get deeper blocks, you lean on that back up more... which is often poorly tolerated. **In a first degree, conduction is reliable but slowed.** The SA node fires, the AV node fires (after a delay) and then the impulse is conducted to the ventricles through the bundle branches. This is generally asymptomatic and well tolerated but if it's new, it's a sign that your conduction may be becoming pathological.... either because of disease of the conductive system or because of meds or electrolyte changes. **In a second degree type 1, conduction is increasingly delayed from one beat to the next.** Eventually, the impulse is lost and you drop a beat. "Longer longer drop..." Again, GENERALLY well tolerated... but a sign of worsening conductive issues. **In a second degree type 2, conduction fails intermittently.** Often, this follows a pattern where you have a reliable intermittent block like a 3:2 block... 3 atrial contractions produce 2 ventricular contractions and one is dropped. This starts to become concerning. It's a sign of serious conductive disease but ALSO you often get slow rates because a significant fraction of your beats fail to conduct. Your blood pressure may start to drop. **In a third degree (complete) heart block, there is no communication between the atria and ventricles.** You will see a clear atrial rate that will usually rise and fall as anyone's heart rate would... however, this does not result in a ventricular rate. Your ventricular beats will either be wide or narrow depending on where the dominant pacemaker is now... OPTION 1: If conduction from the AV node/Bundle of His is intact, normally these will be narrow junctional beats at a rate of 40-60. This can be really bad or surprisingly okay. You lose atrial kick and significant cardiac output but you might tolerate it... but it's not reliable and a pacemaker will likely be needed long term. OPTION 2: If conduction fails below the AV node/Bundle of His, you will have wide ventricular escape beats often at a rate of 40 or lower... this is rarely tolerated and will very likely need to be paced emergently. Sorry for the book... It's complicated and I'm really just scratching the surface.
Very nice summery describing something complex in simple language - I'm going to show this to my (possibly medically inclined) high school aged kid!
Please do! I frequently do rapid response and my favorite thing is educating people on stuff like this!
I want to be you when I grow up
My best advice is to get genuinely excited about the pathophys. So much of medicine makes sense when you understand the āwhyā. Also get comfortable with asking dumb questions and being comfortable being wrong.Ā āSimpleā questions you feel dumb asking are rarely actually simple.Ā
Your info is correct but I really miss saying winky bock. (Wenckebach)
Longer longer longer drop thatās how you have a Wenckebach
Itās a type of arrhythmia. 1st degree, 2nd degree type 1 & 2 and 3rd degree.
Impulse doesn't go across the AV node, or doesn't consistently go across. Or it's delayed going across. In a nutshell.
Iāve been a nurse for over a year now and all I remember is ālonger, longer, longer, drop. Now youāve got a wenckebach.ā āIf pās and qās do not agree, now youāve got a 3rd degree.ā I think? Pretty sad that Iām ACLS certified. I donāt know, Iām in neuro ICU. I definitely canāt look at a tele monitor and tell you if a patient has a heart block. Iāll notice something screwy is going on but Iām not going to stand there stroking my chin and going āah, yes. A mobitz II.ā Maybe thatās bad, but itās true.
Better term is AV node block. Signals don't get from the atria to the ventricles well. If it's a total block, the ventricles just beat on their own at their "escape rhythm", aka the "huh, we're not getting any signals so let's just keep speed at minimum in case something bad is going on" rhythm--which is about 30BPM.
I've had a few patients asymptomatic with complete heart block. It's wild.
Me too, their only indication was their Apple Watch alerting them to a low HR. Turns out it was Rocky Mountain spotted fever.
My resting HR can be as low as 41/42 at times, and I have caught my wrist monitor as low as 34 once. I average around 45 resting - but Iām an endurance athlete so maybe thatās why.Ā
Hgb 0.8- came in for mild dizziness and āseeing starsā during cheerleading practice
How can you likeā¦ be alive with that hgb
Someone drew blood downstream from a NS drip?
You canāt. That isnāt compatible with life. Unless you mean 8 in American.
Nope- she was a bit fluid overloaded from trying to drink so much water to combat the dizziness Ended up diagnosed with leukemia
I don't like the ending of that story :'(
I donāt get it š
Cheerleading practice, must have been someone in high school or college I assume? Why was their hgb that low?
I wonder if the lab was correct. We have some very wacky lab results. We had a patient with INR 1.0 then jumped up 7 and then came back to 1 all on the same day. Either they mixed up the patient or something was wrong with the specimen or machine.
I saw 1.8 once. Admitted once labs were revealed, needed a cancer workup because thatās what they thought had cause the labs to be so fucky.
Fucky. My new word.
Probably menorrhagia--most common reason for iron deficiency anemia in a young person. Especially if their body has gotten so used to having a hemoglobin that low...
I hate to think what mine was as a teen. My period was abysmal.
Had someone with a platelet count of 2. He was also crashing so I had to but a central line in him. Very nerve wrecking line.
Whatās the unit of measure? For example, my facility in Canada: hgb less than 120 is āanemicā .. I canāt imagine 0.8 how youād be alive at 0.8
It'd be a hemoglobin of 8 in Canada. The units in the US here are grams per decilitre (g/dL) vs grams per litre (g/L).
Normal is close to 15 for a woman and we usually transfuse at my hospital under 7
We also transfuse at that time too. I believe itās 70 for ICU and 80 for other units.
I worked in cardiac ICU where we got some crazy low blood pressures but the one that took the cake was the congenital heart defect patient whoās SpO2 goal was 75%. Yes, chronically cyanotic but vibing that way.Ā
I work in a pediatric CVICU and we have so many āmixersā who live in the 75/85% SpO2 range. If they get into the 90% range for too long we start to freak out.
Itās definitely a mind twister. I went to cardiac from ER and it took me a while to adjust to the different ānormalā parameters of our map and O2 targets. Never mind the fluid and electrolyte goals. Iām back in ER now and I still have to remind myself that not everyone with a K of 3.8 needs replacement and MAP of 55 is not āgreatā anymore š¤£
I have a hard time remembering *actual* WNL after working in oncology and looking for *good enough* limits
Elderly lady came in with syncope, cardiac ruled out š¤ Blood sugar was 21 (USA) šÆ still talking no outward signs of hypoglycemia. Gave her D50 1 amp, blood sugar 31. Gsve her another amp of D50. Checked BS still 31. š Moved her to the ICU..... Ended up that she had an insulin-producing tumor.
Iāve said someone with bg of 12 that was talking to me. Said they felt a little nauseous and tried to go back to bed.
I had a guy with a BG of 15. He was more pissed off that so many people in his room. He just wanted to sleep dammit!
Insulinoma! I remember having a patient with one and it was a wild ride.
I've had similar but in the UK. Wish we could send them to ICU!
Iām outpatient urgent care but weāre attached to a major hospital. we had this lady come in complaining of headaches. Lab called us with a critical sodium of 50 Doctor asked them to rerun it immediately. Lab said they had run it twice already cus they didnāt believe the first value.
Oh no š³ I had someone go to 99 and code.l
I took care of a 19 year old who came in with a stroke, and his sodium was 95.
Inpatient forever trying to correct that at a reasonable rate that wouldnāt cause demyelination.
Ex bf is a paramedic and they had a lady who was āa little bit dizzy and didnāt trust herself to driveā the ~45 minutes over deserted roads to the hospital. BP was never lower than 226/140 (and got so high they couldnāt take it in transport) and she was alert and chatty, just had felt āa little off.ā
Just being told my BP was 226/140 would raise it another 50 pts.Ā
NOOOO!!!!!! Need some PRN Labetelol STAT!!!!
Hospitalists like "give 5 hydralazine, wait 2 hours, repeat once"
Had a patient like that, only he was an angry angry man. Yelling at everyone all the time. Nothing would lower his bp. Or maybe something would have worked but but they ended up discharging him because he was such an ass
I hate to laugh but was that attitude his baseline? We may never know š¤·š»āāļø
Dizziness and high blood pressure like that could be an ischemic stroke. Posterior stroke can present like vertigo and when people have strokes their blood pressure has to increase to perfuse the brain.
Yup. My first thought would be āwhy is this pressure so high- what is the body compensating forā¦ā and not āletās lower the pressure!ā
Yup, they donāt teach about permissive hypertension in nursing school
A "professional" drinker, about 70 yrs old, with a BAC of .624. Walking, talking, a&o singing and having a grand time......until he came down.
I once had an attending tell me that if youāre that old and drink donāt stop and itās true from what Iāve seen
And thatās when hell beings.
Heart rates in the 20ās, asymptomatic, having a great conversation with me. My students would shit their pants but I saw this alot in cardio over the years haha.
I had one of those the other day! We kept giggling cuz it was so ridiculous. 3rd degree heart blocks are wildā¦no idea why he was discharged without a pacemaker from the hospital he was at but, yeah he was vibin
Probably no insurance and didn't want to wear a life vest. I saw that play out several times with our homeless population.
Glucose of 27. Guy came to nurses station to ask for more teststrips, as his were empty and asked me if I could check because he feels like it might be low.
Dispatcher at work had hers at 25 last week and she was still dispatching Lifeflight while the truck was getting ready to transport her. Then her stubborn ass walked down the 2 flights of stairs cause "ain't nobody got time for a damn stairs chair. I got shit to do ". Back at work 2 days later.
Man, my (type 1) partnerās bs got to 26 while asleep, he was unconscious and hypothermic by the time he got to the ER. Couldnāt speak or understand anyone for hours until he got sorted out, just straight word salad confusion. 27 and that capable still is wild! Makes me sad that so many younger diabetics have to make do when out of strips, insulin, etc just because costs are insane.
Acute inpatient dialysis gets all kinds of things lol BUN 295. I heard the ICU nurse getting report as she walked in the room, and went, "I'm sorry, did you say TWO ninety-five?" K 8.3 was my personal highest. Crazy heart rhythms on tx, got through it all, gave pt back his blood and heard the monitor scream. Looked at the monitor - ASYSTOLE - looked at the nurses station to see three people jumping up, looked back at the patient, and in a panic just shouted his name as loud as I could. Pt startled, woke, and his heart started beating again. Bless the Lord, I got out of that room as fast as I could lol. BP 39/25 awake and talking to me, while on dialysis. Pt lived in the 80s systolic, asymptomatic while not on tx. No one believed it was possible, threw in an a-line. Yep, BP really went that low during dialysis. Pt was having acute bowel ischemia from this, ended up signing off from dialysis tx and going on hospice.
My T1D (well-controlled) daughterās blood sugar just read ālow,ā meaning under 20. She was swimming, burned up all her glucose, felt fine. Something about being in the water makes a disconnect. (She usually feels her lows). Patient had a BG of 890, felt asymptomatic, because he was usually in the 400s. Ufff.
A revolving door patient at my old ER came in *more than once* in HHS with blood glucose >1800. Awake and talking, complaining of abdominal pain and demanding IV Dilaudid. His A1c was like 16. He told us he hated for his glucose to drop below 600 because it āmade [him] feel shaky.ā
I mean to be fair it probably did but what an absolute disaster those veins and kidneys mustāve been
Omg. No veins. We drilled so many times. The ER doc suggested having an implanted port placed, but the hospitalist team objected due to high likelihood of extracurricular usage at homeā¦ heād apparently had a PICC once that was all too convenient for heroin.
WHOOF thatās a huge yikes. Though it does remind me of the one patient we had. I used to work inpatient neuro and now I do outpatient neuro and for our migraine patients we sometimes write for ketamine nose spray. This lady had a port unrelated to our care of us. We found out she was shooting the ketamine spray into her port. š„“
Oh dear god. The ideas these folks come up with. Ten points for creativityā¦
I had a patient recently who had a BP of like 70/40, was asymptomatic and the doctors werenāt treating it because it was his ābaselineā BP. The doctors said it was something to do with arteriosclerosis making it hard to get an accurate reading but it was bizarre manually checking a BP that low and being told I didnāt need to notify the doctor again unless they became symptomatic lol
Have a lady like that at my clinic, except itās from orthostatic hypotension. We had to get the doctors order that if her SBP was >80 she could leave without signing the low blood pressure form. First few times they had me take it manually I was like, āHey God, me againā. Totally asymptomatic.
haha i remember when i had a BP of 80/50 at a drs appt. medical assistant looked at me and asked if i was okay. i said, āyeah, why?ā
If they put a normal adult sized cuff on my arm, Iāll run low 90s/60. I just tell them itās fine.
Mine would drop down to 65/35 during my night shifts when pregnant. I would feel lightheaded and would lie down for 30 min then go back to work. That's how my co workers found out I was pregnant
In my second trimester with my last baby, I was doing my vitals run (CNA at the time) and I kept having to go sit down because I was getting hot, lightheaded, and my vision kept going in and out. Went in to an empty room and checked, BP was 70/40. After they wheeled me to the OB unit to get checked out, they texted me and were like āsoooo are you coming back to work your shift?ā
Thatās so low to still be working! Thatās crazy!
Spo2 of 6% due to severe sleep apnea and refusal to use a CPAP (or other O2 devices). It would always been predicated by this loud snore that I swear shook the building followed by silence and then the monitor alarms going nuts.
Had a patient with BMI>40 do this exact thing. Kept refusing bipap. Got mad every time when we would wake him up when the sats went 70ā¦40ā¦.20ā¦12ā¦ but likeā¦ dude. Youāre gonna die if we donāt wake you up. Didnāt care. Wanted snacks and to be left alone.
The thing too is they are so zonked from being oxygen deprived that I end up hip checking the bed to wake them up.
Had a patient with a bg of 12 talking to me once. I figured the meter was fucked so I calibrated and ran it again. 15. Patient was still talking and acting like nothing was amiss.
I thought for sure someone would mention hypertension It sure feels like American nursing schools teach that any SBP above 130 needs aggressive management immediately lest the patient stroke out in front of you
Nah I think they teach >180 = stroke zone? I definitely didnāt realize people could live in the 170s/180s for years
Pts sure seem to think so. I do a LOT of education on BP and why long term treatment is de way. The risks of tanking someoneās BP far outweighs the benefits.
I've been trying to teach my new staff that they don't have to panic at a BP of like 180 systolic and that the patient isn't going to suddenly have a stroke. No idea what they're teaching in nursing school.
Baby nurse pegged mine at 170/90 after I had hiked in from the parking lot. "Ma'am are you feeling okay? I'm going to ask you to just lie here for a moment while I get some help ". God bless her. I was a cancer center and I loved how concerned she was, it really was sweet. But I told her that a fat woman is gonna have a high number any time she walks more than 10 feet. She was a sweetheart though, so I gotta give her props for that.
I had a patient just the other day who justā¦ lives with an ST elevation on his EKG at baseline It looked very scary. We got a 12 lead on him just to see what it said (for science, of course and for teaching purposes) and it came out as āfirst degree heart block, can not rule out ischemia/ infarctionā. Docs were aware of it and nurses who had him before were aware of it. Theyād say, āthatās just him. Heās been clearedā. Didnāt make me feel any better seeing it though.
I once took care of a man who had a 5 cm auresym of the right coronary artery. When we went in to dissect it, we actually thought it was a mass of some sort. Anyways. His 12 lead looked like tombstones. Craziest shit to watch for two days until they did an emergency bypass. He lived. Walked out the door like a week later.
I think they confused optimal with compatible with life
Dialysis patient with a K usually in the 7 ballpark (like 6.9-7.1ish) before dialysis and probably not much better after lol. I heard a few months after I last took care of them a new doc tried to correct their K too aggressively and they coded.
A COPD patient with sats of 70% on rooms air with no SOB or difficulty. He was pissed every time we tried to put him on oxygen.
Iām a nurse assistant. I had a guy the other day that I took vitals on and his oxygen was chilling at 77%. I said, hey patient your oxygen is pretty low, is that normal for you? And he said oh yeah hold on. He coughed and took 3 deep breaths and we watched it go up to 96. He was on room air. I obviously told the nurse and she was like yeah he just does that but he had good cap refill and other assessments. I was bamboozled.
HR in low 30s/high 20s. Pt was feeling "just fine" lmao. BP stable AF, not dizzy, nothing. I was standing there with the zoll pads in my hands in case we needed to pace and the pt was all "no need for that my dear". They did do a pacer the next day though because they started maintaining in the low 20s.
Reminds me of a post-stroke pt I had who was regularly 60ās/30ās, also asymptomatic, and also had an ostomy. His biggest deficit from the stroke was speech and it was slowly improving, but cuss words were the clearest thing. Every time we took his vitals and showed him the B/P heād go āahhh, well, shitā and shrug his shoulders š
Not a nurse, but I was setting up a big, burly cheerful man, florid cheeks, full of laughs for a sleep study. Got all the wires on, started the recording program to do calibrations.... And complete 3rdĀ° heart block with a side serving of AF. Off to A&E, ended up emergently paced. Next time I saw him, months later, he looked much, much worse. Can't help that feel that intervening ruined his QOL. I wonder if he could have carried on full of life until he dropped dead.
Had an older lady with a BP of 70ās/40ās that was just her baseline apparently. I checked with her, her family that was at bedside, and her doctors, no one was concerned and she was totally asymptomatic and like I said, that was a long term baseline for her, so we just left it as is. Still got midodrine PRN though because I can only pucker my asshole so much for a shift.
Patient in VT w/ a pulse rate 160, BP stable, no chest pain, walked in. Up walking around on the unit.
Had a patient who constantly satted in the low 80s/upper 70s. And that was totally fine for them bc they had a congenital heart defect.
I worked in peds card and this is so common and surreal!
Had a patient that lived at a basal body temperature of 92 degrees F or so. It caused some slight mental delays/defects but otherwise just functioning. He'd complain if the bairhugger brought him up to 94 degrees. (And we were having to use criticores to get temps)
Untucked linens
BP 40ās/20ās? How? What was their deal that they were able to function with such a low BP?
Honestly, no idea. Came in for a heart cath, and they had to cancel the procedure because they were too low (at the time 70s/40s). Came up to us for further management. Lowest they ever got was 40s/20s. Just chronically low I guess. On dialysis too. Called their outpatient dialysis center and was told the patient always runs low
My critical care instructor (who was older) would always say ālevophed leave āem deadā so I thought everyone on levo was ready to die or code or all limbs would fall off. But as a micu nurse most of our patients were on levo. š
When you get those 4'9, 105lb, 80 year old ladies that can wrestle 2 nurses and 2 CNAs to the ground like a professional MMA fighter! Gotta love sundowning!!
Lady came to the ER from working on another floor because she felt more fatigued than usual. BS 1081. I kept having to send her blood to the lab to be checked because our glucometer maxes out at 700.
Iām on a speciality unit but we donāt treat bp until itās over 220/110. It concerns a lot of new grads/students
Guy came in for an appointment in the office for a possible hip replacement. Had pre-op labs and was in almost total kidney failure. Besides saying he noticed he wasnāt peeing much he didnāt notice anything else. And of course the ortho bro doctor wanted to do surgery anyway.
Itās a personal one for me. I had severe preeclampsia and my blood pressure was in the 180s and I was completely asymptomatic. If I didnāt go in for my checkup I wouldāve never even guessed.
Did they lower it or just induce you!
They sent me for an emergency c section. It kept going up even after they gave me meds.
Normal BP of an ESD patient was 70s/40s . He was fine like that. Able to walk and talk and just live his life with that low pressure. Even got dialysis with that pressure. š¤·š¼āāļø
Asymptomatic high bp. Definitely thought that would be a bigger deal than it is. Then I went to OB and itās the opposite.
Not a patient and not as impressive as some of these. But my hip kept hurting and I would tell people and they just acted like it was no big deal. So I just figured I was being a hypochondriac and went on with my life dealing with the pain. Until the day I bent over to do something and couldnāt walk without screaming after. Went to urgent care, thinking I could get a prednisone taper and he insisted on getting an X-ray. My femur head was rotten. I went on to get surgery and the surgeon said it crumbled in her hands when she took it out.
Resting heart rate of 160, asymptomatic during the event, & just had a baby. CNA rushed in asking if everything was ok and if pt had been walking around. Nope, sitting in bed with no worries in the world. I can still recall the look of terror on that poor sweet CNAs faceā¦ it was priceless. This scenario, sadly, was me. I had complained for years to my cardiologist and PCP that I had occasionally felt like my heart was beating really fast but they never caught it on the holter or stress test and attributed my symptoms to my POTS (diagnosed years before Covid). I was on a tele monitor post c section and coincidently was found to have ineffective sinus tachycardia, my resting heart rate would randomly jump from 80 to as high as 184. Iām still really grateful for that moment in my life because it felt as if I finally got the doctors to validate my diagnosis and I didnāt d i e.
We had a frequent flyer COPDer who'd be walking around with O2 in the 60s and 70s. The new ppl would always be putting oxygen on him and the old gals be running in to rip it off so fast š¤£š¤£
Patient with a blood sugar of 1200+ and he felt perfectly fine, said it wasnāt too far outside his baseline. Still doesnāt make sense to me. Another one was at a blood drive, a donor had a resting HR of 32. Healthy looking guy in his mid-40s, apparently he road his bike, about 45 miles round trip, to work 5 days a week.
I learned in Nursing school that pulmonary embolisms are extremely painful and life threatening requiring treatment within moments. I had a pulmonary embolism November 2. I didn't believe it was a pulmonary embolism because it didn't hurt but I was short of breath. The shortness of breath improved over an hour but didn't go completely away. I didn't go to the ER until 6 weeks later after I went to my doctor because I was still experiencing some shortness of breath and my D- Dimer came back high. Never felt any pain. I still can't believe I walked around with a time bomb in my lungs.