Monday, April 7, 2014

New Nurse Tip: Your patient passes out. Now what?

new nurse, student nurse, renee thompson, rtconnections

Before I became a nurse, I worked as a Medical Assistant at a local women’s clinic in Pittsburgh, PA. I worked in the lab and drew blood on about 50-60 people a day. It was inevitable that out of the 50-60 people, at least one of them would start to drop their pressure and pass out.
When I became a nurse, the same sort of thing happened but sometimes it wasn’t because I was drawing their blood – sometimes it was because they had a massive GI bleed, were septic, or severely dehydrated.
What would be your initial independent nursing intervention if your patient passed out? Pick one.

1.   Drop his head lower then his body.
2.   Keep his head level but lift his legs higher.
For many, many years I’ve listened to nursing instructors and myself tell students that if your patient drops his blood pressure, to immediately lower the head of the bed.
What’s the rationale?
It’s because when your blood pressure drops, your cardiac output drops. When your cardiac output drops, you may not be able to adequately supply your vital organs with the oxygen and nutrients they need. Hence, you lower the patient’s head to allow gravity to help perfuse the brain (the most important vital organ).
While lowering the head down to flat may be a good thing, I’ve seen some nurses put a patient’s head lower than their body (Trendelenburg). And that’s NOT a good thing.
When you lower someone’s head below the rest of their body, this increases pressure (due to gravity) to the major vessels in the heart AND compresses the lungs, thereby interfering with cardiovascular circulation and respirations. These effects can further compromise cardiac output making the situation worse.
So, if you choose option 2, you are correct.
If your patient drops his pressure:
Put his head flat and raise his legs - you don’t need to perfuse your legs to survive anyways!
That’s exactly what we did when I was a Medical Assistant. We’d lower the person to the floor and lift their legs on top of a garbage can. We even kept a pillow in the lab so that we didn’t have to put their head on the cold floor.
Oh… just in case you recently went through ACLS or BLS training…of COURSE you will call for help and follow your algorithm! That just goes without saying.
I hope this clinical practice tips helps. Would love your comments or suggestions for other blog posts. As I've mentioned before...I do take requests!
Thanks for choosing to become a nurse. I'm cheering for your success!
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