A few days ago on the geriatric ward one of the pt's i had been treating had a sudden episode of VF (ventricular fibrillation) and the met call button was pressed. The pt was eventually shocked back into regular rhythm and by the evening the pt was conscious and responsive. The pt had a Hx of SVT and AF and was awaiting the all clear before being transferred to a rehab hospital, which has now been posponed.
The interesting part of this story is that i saw this pt the afternoon before these events, and she was the best i had ever seen her. She was motivated, cheerful and went from 1x assist amb and t/f's to standby assist. She managed about double the length of mobilization and also tolerated a series of bed exercises. I thought she had really turned a corner.
When my supervisor and i were discussing this, my supervisor said that this is often the case and regretted not picking up on it earler. She reported that many pts are able to perform better, look better and are more up beat soon before they 'crash'. This came as an absolute shock to me as it really is the opposite to what you would expect. I would have thought that in a place like gero's unwell pt's would gradually decline, or in a step down process, until eventually 'crashing' or dying. I just found this fascinating and will definately be on the lookout for uncharacteristic cheerfulness and performance and hope that it is not a indicator that the pt is about to 'crash'.
1 comment:
I thought exactly the same thing. It makes sense to me that if a patient was going to 'crash' they would perform worse than normal and I would expect their attitude to be more docile. I guess I expected them to feel generally unwell. This is clearly not the case and I shall keep this in mind in future when treating patients. It's a good bit of information to have in the back of your mind and it seems like the type of thing that could be quite useful. I would have been just as shocked as you if it had happened to me!!!
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