Posted on 01/28/2011 12:37:08 PM PST by Brytani
Medical question for you all.
Yesterday, out of my own stupidity, I ended up in the Emergency Room with chest pains, rapid heart rate, super high blood pressure, lightheadedness and low blood sugar. We thought I was having a heart attack and Thank the Lord it was not.
On Monday I had met with my GP and had asked him to take me off of one medication I've been on for about 6 months, and replace it with another. He was agreeable to this but did tell me I needed to taper off using the former medication and told me how to do it. Knowing I know better than my doctor (yea - lol) I just went cold turkey. My body let me know yesterday I'm not smarter than my doctor.
After multiple tests to figure out what was going on, the ER doctor came in to fill me in - my heart was fine, thankfully, very strong. This type of reaction can do serious harm (if not permanent end of life) to those with a weakened heart. Before leaving he told me he was going to give me something there so that I would feel better and a medication to take home, then directed me to return to the previous medication and go off it properly.
Here's the problem and question. The female nurse I had assigned to me had a bad attitude from the moment I got into the ER. When I was first wheeled into the room the bed was not made. Another guy made the bed and got me into it. The nurse came in and chastised me, wanting to know why I'd made the bed....huh?
After a bit a line was put into my left forearm, about 2 inches below the elbow, the line was closed and taped over. Above that BP cuff was placed along with the oxygen monitor. It took over 30 minutes (hubby timed it) to complete all of this, the longest being the line. After being stuck 4 times by one person, I asked for someone who knew what they were doing. My nurse called in another tech who took the line and on the second attempt got it into place.
After waiting a few hours and speaking to the doctor, the nurse came in to tell me she was giving me medications for nausea and something for pain.
This did not make sense to me, I was not nauseas and was not in pain. I asked her why those two medicines and was told "well fine, I'll just put down you refused them!".
Trying to hold my temper, I told her I was not refusing the meds, I was simply asking why those two without something to stop the reaction I was having for stopping medication too abruptly. At that point she said ohhh and he's giving you (another medicine) which cleared things up. In fact, if she had told me the three in the first place, I would not have had to ask any questions. But, I guess to this lady, asking a question is refusing them.
It's what happened next that I really need to find out about. The drugs were mixed with I assume saline and injected into the IV line. The first burned/pressure but nothing to bad. The second one went in and there was real pain which she dismissed as "it happens to everyone" when I sort-of gasped. The third has me angry, a bit concerned and wondering what to do.
As she was pushing through the third medication the pain was pretty intense, burning, ripping, high pressure feeling as she began to push the 3rd med through she simultaneously turned ON the blood pressure cuff right above the IV line. When that turned on and began applying pressure, I was literally watching a large bump grow on my inner arm to the size of a walnut. I expected it to pop open or push out the IV there was that much pressure and very intense pain.
When I was released from the ER and the line was removed, I had an almost rock hard, solid lump, where the line had been the size of a golf ball that was tender to the touch. I showed this to the nurse who said "oh, you have a hematoma" and walked away. Today, the lump is 3/4 the way down but my arm has a bruise almost 5 inches long, 2 inches wide and hurts from any touch/pressure.
1. Is it proper to turn on an BP cuff while pushing into an IV line medicine that close to the cuff?
2. Should I complain to the hospital administrators about not only her attitude (which we had planned on doing, there was much more than I wrote) and also my arm and the condition it is today? Also, in ER medicine, does the fact a patient wants to know the reasons why a medicine is being given considered a "refusal" by the patient?
3. Just in case, is there anything strange I should look for if this gets worse?
4. Before anyone asks, no I'm not suing. No ambulance chasers are in my future.
Thanks!
Thanks for the reminder why I’d left FR months ago.
Potassium is one medication that burns really, really bad when being put in by IV. Sometimes you can get them to also inject pain medicine at the same time.
The chest pains were pretty bad for a good 30 minutes before and after I got to the hospital. By the time they finally got me into a room after giving me tests etc, it was almost 5 hours later, by then the pains had subsided.
The hospital should have a Patient Advocate on staff. Report the incidence of your condition to them, along with a description of the discourteous treatment. Get an opinion from your General Practitioner about what caused your unusual condition. Supply that to the Patient Advocate.
I recently had some surgery at a hospital. Some of the nurses were very nice, some not so nice. Even the nice once put me in a room for 2 hours and never bothered to check on me. I had to drag my IV into the hallway in search of a bathroom. Nobody even realized I was gone and I didn’t even see a nurse around.
Anyway, they sent me a form to grade their performance. Maybe you will get something like that.
1: It is NOT good practice to inflate a BP cuff while giving IV medications, especially if the medication must be given slowly. The effect is that instead of a slow, steady dose, the patient ends up receiving a bolus dose that can be harmful.
2: Yes, complain. And no, asking questions about a medication does not constitute a refusal.
3: If you have any continuing discomfort in your arm, worsening swelling or pain, you need to see a provider right away. Some medications (especially Phenergan [promethazine], a common anti-nausea medication), if allowed to leak out of a vein into surrounding tissue, can cause tissue damage and necrosis (tissue death). This is a medical emergency that must be addressed. I don't know if you received Phenergan for nausea, but from the way you are describing how much it hurt, it sounds pretty characteristic of Phenergan.
You have the right to advocate for yourself. That includes asking about the meds you received. Keep a close eye on that arm. Talk to the administrator and the ER manager about your experience.
I hope that helped.
If the ‘bump’ is still present with bruising, redness and pain you should return to the ER for follow-up ASAP! (I am assuming your regular physician is not available on an emergency basis).
Go back for treatment and not to register a complaint. Complain by letter - detailing all your experiences. Face-to-face confrontations can wait. Your health is the more important concern.
BTW - Medical personnel used to treat patients as paying customers...no longer - we are just part of the herd. Times they are a’changing.
>>2. Should I complain to the hospital administrators<<
YES
I’m just teasing you. No harm or foul intended. Honest.
Freepmail to ya
>>2. Should I complain to the hospital administrators<<
YES, in person! Do not write a letter as was earlier suggested. That’ll be brushed off easily. Make an appointment with the administrator and go in a rip some butt. Let him/her truly think that your money hungry attorney is begging you to take this case to court. Ask if she/he is going to swallow all the bills for your uncomfortable stay.
That will produce serious changes and results for you should you ever have to be admitted to that hospital again.
Marry a RPh.
And... just a heads up... there’s only one way to tell definitely about a heart. A cath lab and choose them well (one where they can crack you open if something goes to hell.
Quit playing Dr.
The BP cuff could have been put on the arm without the IV line.
The nurse was pushing the medications too fast through the vein, which would cause the pain and discomfort you described. The drug reference books for nurses tells the speed each med should be pushed. Few nurses pay attention to that, IMO, unless they are recent nursing school graduates.
Report this in writing, for sure.
Bluebird RN
/mark
A pH of what? Acidic or Basic?
Thanks for the info. Like the poster I thought that was not a good technique. You guys have cleared up why.
“if allowed to leak out of a vein into surrounding tissue”
I’m not a medical provider, but am married to one. A hematoma means blood leaked out of vessels into the surrounding skin. From what you describe, this may well have been a iatrogenic injury—i.e., one caused by their incorrectly inserting your IV, as opposed to something that would have happened naturally as a consequence of your heart event. I would guess that even if no medication also leaked, the hematoma itself would have caused pain—especially if it reached golf-ball size.
Golf-ball sized hematomas are surely not a “normal” side-effect of getting an IV. You don’t need to sue, but you sure should bring this to someone’s attention as it sounds like aside from getting a lousy attitude, you may also have gotten poor quality care. Any decent hospital would want to know about that.
Not speaking from a medical point of view, but a common sense one, people make almost an unavoidable error of assuming they know what other people are thinking or feeling, and this often has strange results.
Introspectively, you and your spouse were likely agitated, upset, in discomfort, confused and very concerned. But this was all inside. What it might have looked like to this nurse was something very different.
Likewise, she may have been having a heck of a day, and had all sorts of preconceived notions about what you and your spouse were about.
Now this does not excuse in any way unprofessional behavior, but it is often easy to set off strangers who misinterpret where you are coming from.
It is the job of an ombudsman, or other hospital administration type, to first figure out if anything objective was done incorrectly. So when you talk to them, to speak of these things *first* really clears the air and gets them on your side, because it says that you are *not* just a hothead or complainer, that there are some medical issues at stake.
Only after you explain these should you mention her attitude or behavior. With a solid foundation of objective information, this gives these much more weight.
I have pinged Taz to this, as she is a wonderful R.N.
I am a Medical technician, so will comment on what I know.
In the first place, the treatment you received was appalling!
The fact that she had the BP cuff on the same arm as the IV just has me incredulous!
That should not have happened, period!
There is a patient bill of rights, please look here:
http://en.wikipedia.org/wiki/U.S._Patients%27_Bill_of_Rights
You are within your rights to refuse any medicine or care that you do not want.
That nurse was an incompetent boob.
If you were my Mom or sister or friend, I would have raised the roof!
Please make an appt to talk with the administrator.
Keep an eye on that arm!
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