Friday, March 13, 2015
Down and up and down and up and down again
Had a pt today.... admitted with CHF and A-fib - report indicated no issues
when I got her her VS were great, no probs
Half hour later (approx.) she becomes confused, diaphoretic, RR increases, decreased consciousness (very drowsy).... so I'm thinking worsening CHF....
Give some lasix IV push and half hour later no change.... like seriously...
so about 15 min later I see that I have to take her BS.... then it hits me - shit balls she's low
BS comes back..... 1.7!!!!!!!!!!!!!!!!!!!!!!!!!
Now for those of you who are not from Canada.... that's like 30 in the US
I say absolutely NOTHING and RUN (oh yes, I seriously did!) and pulled some D50 (Dextrose) from my pyxsis and pushed that puppy straight into her vein... then waited for her to gain some consciousness!
Two minutes later she perks up and I push some OJ, crackers and cheese down her throat.... I tell the family about her low sugar and the grand daughter goes "oh ya, this has happened before and this is how she is when this happens"..... face palm!
When I retake her BS it's 8.8 - well at least she reacted well!
Goodness I can't believe I missed this one..... but wait, it gets better!!!
Dinner comes 30 min later and I make sure that the family is aware that she needs to eat all the protein stuff.... which thankfully she does.
Bedtime comes around and I check her sugar and it's 3.5 (think 50ish) - DAMN IT!
I push D50 again and push a banana (her potassium was low today anyways, she could use it!) and some glucerna (nice protein content).... then I get busy doing bedtime stuff and when I get a chance to recheck it an hour later....
it's 3.4!!!!!!!!!!!!! GAH!!!
Who the HELL runs thru that much sugar in an hour! I call the Dr as I'm not sure whether I'm supposed to push another amp of D50.... thankfully he calls back right away.
Tells me to give another amp of D50 and to recheck her sugar in another hour.... so just as I was leaving shift sugar is rechecked and it's 6.8 (think 115ish).... well that is a WHOLE lot better but I doubt that it will stay that way.
Moral of the story: I have no idea how this woman blew through so much glucose on my shift! She doesn't have an infectious process, isn't running a temp.... and can't put her on a D10 drip because she's already fluid overload.... so who knows what they're going to do with her... I suppose keep pushing D50 amps??? CRAZINESS!
THIS is what I get for having time off.... seems that when I do I always get a shit storm when I get back (this past weekend was no different!) Geeze, how are things going to be when I'm off 3 wks after surgery?!
at 4:44 AM