Jason, MSN-NLM RN CEN

I had a patient come in via ambulance for “drug withdrawal, per family.” Husband called 911 because she had been acting weird all day, and she has a history of abusing her prescribed opioid medications. The patient admitted that she had also abused them today because of her headache that wouldn’t go away. She was assessed by the physician who came to the nurses station and told me “we’re going to do some basic psych labs on her and then we’re going to send her to rehab.”

I go in the room and she tells me she has to use the restroom, and since I needed a urine sample, this was great news! I help her up and say “okay, the bathroom is on your left” and she proceeds to look to her right. I tell her again, “no, the bathroom is on your left” and she proceeds to keep turning right until she is facing the bathroom, and then says “oh! there it is!”

Hmm... Interesting... I tell her “I’m going to do a quick assessment. keep looking at my nose and tell me how many fingers I am holding up.” As I held 3 fingers up in her left visual field she looked at me confused, looked at the hand sitting by my side, and says “you aren’t holding any fingers up.”

Now we’re rushing: Stroke alert, CT scan, placing an Ultrasound IV line for Angiography, and scrambling to call anyone to find her last known normal time. When it was all said and done, she had a confirmed occipital-temporal stroke. Unfortunately, there was nothing left that could be done because she hadn’t come into the hospital that morning when symptoms began, but instead of being sent to involuntary drug-rehab that day, she was admitted to the hospital.

2016-2017 flu season: 38,000 deaths

2017-2018 flu season: 61,000 deaths

2018-2019 flu season: 34,200 deaths

2020 COVID pandemic: 93,606 deaths as of today.

I think this data is self explanatory.

Check my sources.

https://www.cdc.gov/flu/about/burden/2018-2019.html

I liked the idea of patient care rather than patient diagnosis and treatment. In addition, I knew that if i did my 4 years of nursing school and decided I didn’t like nursing, I could get my doctorate in nursing and practice in nearly the same capacity as a physician. 

As for the knowledge, nurses are trained to recognize and treat a lot, but much of what we know how to do is buying time. Low blood pressure? hang a liter. Low oxygen? maintain an airway and put them on a non-rebreather. Chest pain? do an EKG. Traumatic cardiac arrest? start ACLS. Physicians are trained to find the problem and find a permanent solution. Low blood pressure? its sepsis: start antibiotics. Low oxygen? its a pulmonary embolism: push TPA. Chest pain? It’s a STEMI: remove the clot. Traumatic cardiac arrest? Bedside thoracotomy.

A patient came in after taking a 60 day supply of 25mg Carvedilol. He presented with a heartrate in the 50's, and a blood pressure, well, also in the 50's. 50/30 was the lowest. He was drifting in and out of consciousness, so we pushed atropine, the first line drug for bradycardia, to no effect.

You know it's gonna be fun when you call poison control, you tell them what's going on, and their first response is "ooooo that's not good." Poison control recommended Glucagon, 5-15mg IV push followed by a drip of 5-15mg every hour. This comes in 1mg vials, so we had to mix and draw up a lot of these vials. (See below)

He did respond. His pulse was now around 80, and we kept his blood pressure between 95 and 105 systollic. He was placed on a drip of 10mg/hr. I feel sorry for the pharmacist that had to mix the bag of 30mg of Glucagon. Central pharmacy also told us they only had 6 more glucagons in stock after making this bag, so if he wasn't better in 3 hours, we would have a problem.. but that was a problem for ICU to handle (I love you, ICU nurses)!

Glucagon has inotropic effects that bypass the beta blockade, this allows it to increase heartrate and blood pressure even in the presence of beta blockage. Glucagon also counteracts the negative effects of the beta blockade on a patients blood sugar.