Cardioverting Pants

[VFlutter]

I work as a Telemetry Monitor Tech at a Hospital and last night I had a patient who was on one of our med/surg floors. The most frustrating part of my job is calling Nurses who have no cardiac experience and trying to explain to them what is going on with their patient, it is like talking to a brick wall. This is a conversation I had with a Nurse which I thought was funny, maybe it was just the situation and 11 hours of work but here is is anyway.


Me: "Hey, you need to check on your patient in Room X he is sustaining AIVR in the 90s they were previously Sinus Brady 40s"
Nurse: "What is AIVR?
Me: "Accelerated idoventricular Rhythm, it is a ventricular rhythm, basically slow V tach (Trying to explain it so she understands)
Nurse: " Ohhh. Well he is getting dressed and trying to put his pants on" I am assuming she said this because sometimes we call when it alarms V Tach when the patients are up moving around just to check them anyway.
Me: "No this is not an issue with the leads he has converted into a different rhythm then he was before, I would give the PA a call"

So she hangs up the phone and I got a call a few minutes later....
Nurse: "Hey, I put his pants on him, is he any better?"
Me "NO, you putting the patient's pants on did not make him any better he is still in AIVR and has been for the past 10 mins. Did you call the PA?'
Nurse " No, I was helping the patient put his pants on"

Really??:censored: :blink:

 

[Handsome Robb]

Wait I don't get it, why are you monitoring their patients and having to call them if something changes? Can't you just tell them in person or are you not on the floor? I've never been on a med/surg floor so I don't know how it works.

 

[VFlutter]

Wait I don't get it, why are you monitoring their patients and having to call them if something changes? Can't you just tell them in person or are you not on the floor? I've never been on a med/surg floor so I don't know how it works.

I am not on the same floor. We basically have an "office" in the hospital. My department is part of our cardiac care unit and we basically loan out monitors to all the other floors of the hospital such as med/surg, Oncology, etc. The nurses come get a monitor from us and then we watch them on our computer screens and document their rate/rhythm and such and then notify the nurses of any changes and send strips. Regular floor nurses do not have any telemetry certification so they can not interpret rhythms so we do it for them.


This is a similar set up to what I have. I usually have around 40-50 patients on my monitors at a time.

 

[Handsome Robb]

Gotcha. I had never heard of that.

Wait RNs can't interpret rhythms? They have to take an extra telemetry course?

It all makes sense now, I couldn't figure out why all these nursing students were asking me a million questions about 12 leads.

 

[VFlutter]

Gotcha. I had never heard of that.

Wait RNs can't interpret rhythms? They have to take an extra telemetry course?

It all makes sense now, I couldn't figure out why all these nursing students were asking me a million questions about 12 leads.

It depends on where you work and if you have ACLS (Not all nurses have to have it). RN's "can" interpret rhythms on normal floors however they usually do not know anything except sinus, A fib, and the Code Rhythms (Hopefully). Most do not have enough experience to understand or recognize more complex rhythms. Nursing school really lacks detail when it comes to cardiac rhythms, it is very basic. I ended up teaching a lot of my classmates since our teacher basically skimmed over a crappy powerpoint. On our Cardiac floor RN's have to take an extra class on rhythm interpretation as well as be ACLS certified before they can work on the floor. If a nurse is pulled from a different floor then one of the other RN's has to watch the pulled RN's patients on monitor and document for them.

 

[Pneumothorax]

They don't teach us shish about rhythms in RN school. Unless you take the initiative to learn it, or have been exposed to such things before RN u won't ever know it. ACLS is req'd at our hospital but doesn't mean the nurses know what they are looking at either.

Just accept it and walk it off lol.

 

[JDub]

I had a job as a Monitor Tech for about a month. Worst job I have ever had in my life.

Do you have to print out and analyze all of your patient's rhythms and any ectopies like every 4 hours? My hospital of course tried to save money by not hiring enough techs, so we were drowning in paper work at all times, which meant that very little attention was being paid to the monitors, so when we did get a break we would have to be scanning backwards to check if we missed anything, which also caused us to not see what was going on the present.

But I really agree with you, I hate when I would call nurses and tell them that their patient converted from Sinus Rhythm to Afib w/ RVR and then they would not only ask me what the RVR meant but then they would be like "well what should I do?" I don't know, maybe call a doc, or look at their chart? I'm not in charge of caring for that patient.

Then of course there were the doctors that would come back, ask me for my interpretation of a rhythm and then get angry when I would call it a Afib and they would call it A-Flutter. I understand the important differences, but if you were just going to look at it on your own, why did you even bother asking me? Especially when I have much less training than them.

EDIT: The good thing about the job was that I learned a ton about reading EKGs.

 

[Anonymous]

At the hospital I used to volunteer at the Unit Secretaries in the Direct Observation Units were the ones who watched the monitors. If anything was not right they would notify the nurse and the nurses never seemed to have a hard time interpreting the EKG. If they ever were not 100% sure the charge nurse was usually able to verify.

Oh and the set up was exactly like Chase posted...

 

[VFlutter]

Ya we chart and print every 4 hours. There are two techs we each can have a max of 55 Pts. Haha I constantly get asked what they should do. I usually tell them to go check and see if they have a pulse and then call me back. That usually makes them actually check the patient. Or I love the excuses I get from nurses. Like "oh they are sleeping" or "on the commode" well most people don't go into V Tach when they are sleeping or pissing.


Just a few minutes ago on of my patients was sustaining AVNRT in the 200s and the nurse told me it was fine they were going to the bathroom. Um ya the PA gave her an earful when he found out they sustained 210 for 15 mins.

 

[Veneficus]

Just a few minutes ago on of my patients was sustaining AVNRT in the 200s and the nurse told me it was fine they were going to the bathroom. Um ya the PA gave her an earful when he found out they sustained 210 for 15 mins.

So what did the PA do for the patient? :unsure:

 

[VFlutter]

So what did the PA do for the patient? :unsure:

No clue. I think it was more of the fact that she just put the strip in the chart and did not notify anyone.

 

[Akulahawk]

Ya we chart and print every 4 hours. There are two techs we each can have a max of 55 Pts. Haha I constantly get asked what they should do. I usually tell them to go check and see if they have a pulse and then call me back. That usually makes them actually check the patient. Or I love the excuses I get from nurses. Like "oh they are sleeping" or "on the commode" well most people don't go into V Tach when they are sleeping or pissing.


Just a few minutes ago on of my patients was sustaining AVNRT in the 200s and the nurse told me it was fine they were going to the bathroom. Um ya the PA gave her an earful when he found out they sustained 210 for 15 mins.

So what did the PA do for the patient? :unsure:

No clue. I think it was more of the fact that she just put the strip in the chart and did not notify anyone.

Given that the patient sustained the 210 rate for 15 min (and presumably no longer than that) and nothing was probably done, that RN should have gotten an ear-full about that. It's probably a good thing the patient survived so that this can be a very good learning experience for that nurse and others on that floor. I can only hope that the patient's chart and meds order was reviewed/changed to deal with tachycardias... explicitly.

 

[mycrofft]

Great. The hospital has its own internal LifeAlert service. They then hire nurses without prerequisite training and experience at a lower wage to work the units.
Pants...I can see where that would be a "nursing intervention" ;

 

[Aidey]

I don't think the set up is all that unusual. It was the same at the hospital I did my clinicals at.

 

[medic4178]

Gotta love those nurses!