Wednesday, January 6, 2016

Vitals Are VITAL!

So, I shared on the Doctor of Physical Therapy student's Facebook group this insane vitals situation, with a patient I saw this past week. You can find it linked HERE:

Essentially, I had a patient present with absolutely no signs, no distress, no discomfort, no nothing... with a normal'ish blood pressure. But! With a heart rate of 37bpm and O2 saturation of 77%.

Yeah... NOT. NORMAL.

My intent in posting that to the Facebook group was to convey how important it is to take vitals. I know it is still a point of disagreement and contention. Still, I've been told more than once that in any discipline or setting in healthcare, failure to take vitals (when someone goes wrong) is the first place lawyers check in terms of negligence.

Just something to think about. You've been warned.

In any case, I'll get on with this post only to say that it is a PASSIONATE topic for me. If you resonate with me, be on fire with me! If it offends you, I'm sorry it does... it doesn't change the facts. But, I think you'll find that the majority of clinical leaders out there agrees with the position I take.

Here's a quick recap:

Follow Up: Vitals Are VITAL!

To my knowledge, it's a happy ending. Our patient recovered and we can't entirely explain what happened. Personally, I still think referring to ED would've been more prudent -- but, per the policy given & the process followed, she was deemed medically stable enough to stay inpatient. However, the cardiologist involved did suggest "other" avenues of approach given a repeat situation.

My interpretation? I think there was a massively hidden cardiac issue given the "regular" irregular heart rate, history of complaint of chest pain, fatigue, etc. Doesn't that sound like a heart attack to you? Sure, the question: What could we have done? Comes up. Maybe nothing, maybe everything.

The fact is, without taking those vitals, most clinicians would've gone ahead with a full course of treatment for the day. That would've included a lot of exercise, both strength & cardio; exercise that very well may have cause the situation to go from odd into critical.

My follow up, simply stated, is this: Vitals are vital, not just because they are standard of care. Not just because it may implicate negligence when omitted. Not just because it's the right thing to do.

Vitals are vital because they serve as the prerequisite for just about EVERY physical therapy intervention we know. Exercise? It starts with vitals because we are causing a physiological stress response. And... I could go on. But, I just stopped typing this long list because it's exhaustive to even do so. Really, if you can't think of why and how important the cardiorespiratory system -- one QUARTER, mind you -- of physical therapy practice is, in how it interacts and is interdependent with the other three systems we treat... someone, needs to rethink how they practice.

Harsh? Sure. But, vitals are vital. Don't you dare put your patient at risk, ever.

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