Your patient is here for hip replacement surgery, but is placed on a monitor because of his age and a strong family history of cardiac problems. You note on his monitor that his heart rate is 120, and it is a sinus tachycardia. You check his vital signs and find that his temp is 97.8 T, RR 24, and BP is 130/80. He denies exertion as a cause for his tachycardia. What are some things that could be happening with this patient?
There are many possibilities, but one that we want to rule out right away is pulmonary embolism. You should have a high index of suspicion for pulmonary embolism in unexplained tachycardia!
Keep watching those patients! Barbara
I always associate pulmonary embolism with chest pain. Is it possible to have only tachycardia as a symptom? What would be the reason for that? Thank you, Jo
ReplyDeleteJo, although patients with PE most often report chest pain, it sometimes occurs without any report of pain. The patient I described in this post was a patient of mine, and I couldn't figure out the cause for the tachycardia. The cardiologist that I called immediately suspected PE and the patient was sent for a CT that confirmed it. It's one I'll never forget! Barbara
DeleteBarbara,
ReplyDeleteAs a brand new (read first day) charge nurse on the 3-11 shift I was making rounds. The patient in the first room had a hip replacement but was going home and was dressed. She had an embolism and eventually died. I tend to be overprotective now.
I think we see less PE now that there is so much evidence-based practice. The implementation of low dose heparin, and/or sequential compression devices, the incidence is definitely decreasing.
DeleteBarbara,
ReplyDeleteI just found out my first attempt to comment did not go through. My first experience with a patient with a PE was with a mid-age woman who was two days post op hysterectomy and was doing very well. It was way back when so she was not on a monitor. She was sitting up talking to her family when I came into the room to do some sort of task. She did not complain, she was not short of breath, she just smiled at her daughter and her head flopped to her side. She died. It was an embolism. I will never forget it.
Deb P.
Deb, my grandmother died from a PE while she was in the hospital for an unrelated condition. It was also very quick. I wasn't there, but my mom said that she had been doing very well right up to the time she coded. I try to keep a high index of suspicion, and I am all over DVT prophylaxis. Barbara
Delete