I was on my ortho inpatient prac, getting a day one THR patient up for the first time. His Hb was 112, blood pressure was 116/74 (supine) Sp02 = 98%2LNP and he had adequate pain cover. His post op orders were SOOB, ambulate FWB day one.
After performing bed exercises the patient was transferred 1 * min (A) into SOEOB (sitting over edge of bed), and his oxygen was taken off. He reported he was feeling really good and was pain free sitting out of bed. Objectively he was alert, had good colour in his face and was not sweating.
My supervisor had told me to take all THR and TKR patients’ blood pressure day 1 before getting them up for the first time. So I had the blood pressure machine close by and began to take his blood pressure. Whilst I was taking this blood pressure the patient reported he was feeling dizzy. So I told him to take a deep breath and wiggle his toes. 10 seconds after he reported dizziness he lost consciousness, his eyes rolled back and his body slumped backwards. I was able to catch him and reach for the MET call button a nurse ran in straight away and assisted me to get him back into bed lying supine.
As the patient lost consciousness the blood pressure reading finished, it came back as 88/43 and Sp02 = 96%RA. Lots of doctors ran in put him on 20L 02 via a mask. His next BP reading in supine came back as 100/50 with Sp02 of 100%. The patient regained consciousness wondering what the big fuss was about not remembering the event.
I stepped back hoping I didn’t do anything wrong. The doctors asked me what happened and told me I did the right thing. I thought doing the right thing would have avoided the MET call. The doctors put the loss of consciousness to a vasovagal syncope.
Reflecting on the event, I know I should have helped him straight into supine when he first reported dizziness. I was too worried about getting a BP reading and didn’t monitor him closely enough.
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3 comments:
This situation would've been vastly different if it was a smaller female or male (Will), PT student.
In saying that your quick thinking was very impressive in the scenario and I don't think you did the wrong thing, all you can do next time is maybe 'tweak' your approach so that like you said you lay the patient back straight away.
Thanks for sharing this experience with us. I am currently on an Orthopaedic IP ward. I have been assisting post THR and TKR patients OOB for the last few weeks, but fortunately have not had anyone faint yet.
I'll take your advise and focus more on their symptomatic response, rather than their BP and Sats.
I experienced that at my ortho ip placement too. I was more fortunate in the sense that the supervisor was with us and it was a x2 assist to stand for the first time.
We managed to get good BP and sats reading before standing him but about 10 seconds after patient stood with the supervisor and the other student, they felt him go weak and just passed out. They sat him back down and back into supine and immediately he regained consciousness.
I guess the thing to take away from this experience is that patients no matter how good they feel can go in a matter of seconds and its always better to be prepared for situations like these.
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