OP here...
Thanks for all the great discussion, really helps me and I feel better about my decisions! Here's basically what happened:
For a little more information: The environment was an ambulatory surgery center that is across the street from the main level 2 trauma center with all the ICUs. There is an underground passageway that connects the two allowing for transferring patients to the inpatient environment. The ED is the first location you run into on the other side of the underground passageway.
-First thing I did was pull him up in the bed and sat him upright with the RN. O2 to 10L
-She was having a hard time getting a BP for whatever reason, I think because he was wiggling a lot. I had my fingers on his foot pulse in the meantime, and instructed her to focus on getting me a BP, which she eventually did. Called for a code cart and rapid response team.
-CXR was done before I arrived. Since we got a blood pressure and sats were 93%, I felt I had time to get an EKG. His prior EKG was from a few days ago showing controlled AF. Current was AFRVR.
-We administered lasix and then RRT arrived with an ED doctor. He and I discussed and agreed to give 10 mg diltiazem then transfer him to the ED for further eval.
-RT started working on getting a blood gas at this point.
-From the looks of him, I seriously considered BiPAP but wasn't really sure. I really really didn't want to intubate (and we didn't) but he looked like he needed SOME sort of respiratory support.
I think it would have been a good idea to try to get in contact with the anesthesiologist who did the case. Or else just gotten more history from his chart since I had some time. I was wondering whether or not to use his AMS as a sign of unstable tachycardia but with his prev EKG of AF I decided to rate control instead.
Thanks for all the great discussion, really helps me and I feel better about my decisions! Here's basically what happened:
For a little more information: The environment was an ambulatory surgery center that is across the street from the main level 2 trauma center with all the ICUs. There is an underground passageway that connects the two allowing for transferring patients to the inpatient environment. The ED is the first location you run into on the other side of the underground passageway.
-First thing I did was pull him up in the bed and sat him upright with the RN. O2 to 10L
-She was having a hard time getting a BP for whatever reason, I think because he was wiggling a lot. I had my fingers on his foot pulse in the meantime, and instructed her to focus on getting me a BP, which she eventually did. Called for a code cart and rapid response team.
-CXR was done before I arrived. Since we got a blood pressure and sats were 93%, I felt I had time to get an EKG. His prior EKG was from a few days ago showing controlled AF. Current was AFRVR.
-We administered lasix and then RRT arrived with an ED doctor. He and I discussed and agreed to give 10 mg diltiazem then transfer him to the ED for further eval.
-RT started working on getting a blood gas at this point.
-From the looks of him, I seriously considered BiPAP but wasn't really sure. I really really didn't want to intubate (and we didn't) but he looked like he needed SOME sort of respiratory support.
I think it would have been a good idea to try to get in contact with the anesthesiologist who did the case. Or else just gotten more history from his chart since I had some time. I was wondering whether or not to use his AMS as a sign of unstable tachycardia but with his prev EKG of AF I decided to rate control instead.
