Nurse Story Time: My Patient Was About To Crash 🩺
I’m going to tell you about this 1 line I got in report that told me this patient was going to crash.
“He’s been desatting a bit, but he’s stable.”
That one line had my skin crawling. I had a patient on high flow oxygen, history of CHF, and borderline stable vitals — but no one thought to escalate care. TWO hours into my shift, we were bagging him.
In the very beginning of my nursing career (like fresh off orientation) I used to take report face value. If the nurse told the patient was “stable”, I believed it. But now I’ve learned to read between the lines.
Now when I hear things like:
“They been kinda boderline, but they’re fine..”
“I couldn’t draw the labs, but they look okay..”
“Yeah, they been needing a little more oxygen than usual today.”
I stop and immediately dig deeper. Ask more questions and look through your chart! Because stable one minute doesn’t mean they’ll be stable the next.
💬 What subtle red flags do you listen for in report?
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Building on my story, let's dive a bit deeper into what 'desatting' truly means and why it's such a critical red flag in patient care. When we talk about a patient 'desaturating,' we're referring to a drop in their oxygen saturation levels, often measured by a pulse oximeter. Ideally, we want to see these numbers in the high 90s, but anything consistently below 90% typically warrants immediate attention. My experience taught me that a number alone never tells the whole story. While a patient might be 'desatting a bit,' it's crucial to assess why and how they are tolerating it. Is their respiratory rate increasing? Are they using accessory muscles to breathe? Do they look anxious, confused, or unusually tired? These are all vital clues. I've encountered situations where a patient's oxygen saturation was technically 'okay' at 92%, but they were working so hard just to maintain it. That's not stable; that's a patient struggling, and it's a sign that their respiratory support might need adjustment. It's a prime example of why nurses must look beyond the monitor and at the whole clinical picture. Common reasons for desaturation can range from underlying conditions like Congestive Heart Failure (which my patient had), pneumonia, asthma exacerbations, or even something as simple as poor positioning or a kinked oxygen line. In the hospital setting, it's our job to troubleshoot these possibilities quickly. I always start by checking the oxygen flow meter and tubing to ensure everything is connected properly and the patient is receiving the prescribed oxygen. Sometimes, a simple repositioning can make a world of difference before escalating to higher oxygen flow or calling a doctor. I've seen countless oxygen flow meters in my career, and ensuring they are set correctly and the oxygen is being delivered efficiently is a basic yet critical step. My personal rule now is: if a patient is 'needing a little more oxygen than usual' or their sats are 'borderline,' it's time to investigate. It means asking more targeted questions, performing a thorough respiratory assessment, and reviewing their chart for any recent changes or trends. It’s about being proactive rather than reactive. This critical thinking is what separates good nursing from great nursing – recognizing those subtle shifts before they become full-blown emergencies. And sometimes, these respiratory issues can stem from infections, which reminds me how crucial infection control measures like hand hygiene, wearing a surgical mask when indicated, and ensuring dedicated equipment is disinfected are, especially when dealing with vulnerable patients on droplet precautions. So, next time you hear those 'stable but...' phrases, remember to trust your instincts, dig deeper, and ensure you're providing the best possible respiratory support and care. Your patient's safety depends on it!
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