Today I WON at patient assessment- Moaning Dood was an intractable pain patient- essentially, we pumped him full of more pain meds than I've ever seen given, and he would mutter "it's still an 8"...and then go to sleep.
On one of these visits, the nurse was pushing the IV meds (we DO NOT do IV push, it's apparently a legal risk) and I decided to take advantage of Dood's distraction to do a reassessment of his pulses, dont ask me why. I laid the backs of my hands on his calves and...um...hummmmmm....
One leg was noticeably cooler than the other one! I'd read about it, and been lectured on it, but it was REALLY obvious. So I tried to get a pedal pulse, and couldn't find one, so I ran to the ICU and stole their Doppler...which ALSO failed to find a pulse. At this point I dragged the nurse back into the room to check my findings AGAIN, and when she couldn't get anything with the doppler, we decided it was time to call in the doctors.
It turns out he had been scheduled for a doppler scan of all limbs back on friday...but then it was the weekend and it was never done. He's hypercoagulable. I hope we saved his leg- since it still had capillary refill, some blood must have been getting through, hopefully enough to hold it for a while.
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4 comments:
Good job!!! What was his admitting Dx?
ED RN
Intractable pain + pleural effusion secondary to non-resectable liver cancer with mets to lungs, bone, and abdomen. He had pathological fx of his R arm as well, from pulling himself up in bed. NOT a happy diagnosis
way to go!!!!
Your blog keeps getting better and better! Your older articles are not as good as newer ones you have a lot more creativity and originality now keep it up!
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