Wednesday, January 10, 2007

And away you go!

NewFNP has noticed that it is, in fact, getting easier to know when to send patients to the ED. NewFNP has harbored a fear of over-reacting and sending patients to the ED when they are merely suffering from gas or a plateful of questionable seafood.

It's a fault of newFNP's training program, frankly - not enough experience with emergent patients.

Anywho, newFNP send yet another patient to the ED today. This lady weighed 350 pounds, had a smoking history of 35 pack years, sat for a multiple-hour car ride six days ago and has had exquisite left calf pain for 4 days. No relief with anything, worse with walking. NewFNP's clinic does not have the diagnostic equipment to rule out the DVT and newFNP's patient was at too high a risk to watch and wait. Was she short of breath? Hell yes she was, but who's to say whether it's from the magical combination of obesity and smoking or not? Her lungs sounded fine, but who can trust an auscultation through 2 inches of adipose? Did newFNP feel a cord, a pulsating mass, an area of increased warmth? She did not. However, this woman's calf had the circumference of a watermelon. NewFNP couldn't feel a thing.

Now, in general, newFNP hates to be wrong. However, newFNP hopes to be wrong about this patient. NewFNP hopes that she has some muscle spasm/arthritis/hypersensitivity - whatever. She just has to be sure. Yesterday, newFNP send a 16-week primip to the ED because she couldn't find a FHT after multiple attempts. Thankfully, the ED saw the heart beating on ultrasound. NewFNP is very thankful that she was wrong and doesn't want any patient to have a bad outcome to prove her right.


allamadogo said...

A good way to get FHTs in the late 1st trimester/early second is to start by placing the transducer just superior to the pubic bone at the midline angling it down and in (as if towards the unpregnant uterus) and then just work your way up along the midline until you hear the FHTs, rotating the direction of the transducer as you go. Also, if you do a lot of prenatal care, you might try to get your hands on a Pinard's fetoscope. I hear FHTs better with these and it helps identify the lie as well. It's nice to have the doppler as a back up and also so that the mom can hear the FHTs, too. Love your blog by the way.

"Loving Pecola" said...

I didn't know FNPs provided care for pregnant women! At what point does the patient transfer to an OB or Midwife?


Anonymous said...

New FNP,
I just stumbled onto your blog by complete accident and I wanted to know - do you think your education as an accelerated provider has worked for you? I'm waiting to hear from two expensive accelerated MSN programs on the East Coast and getting worried reading the very vague info out there on job success if you didn't go the so-called "old-fashioned way." My gut says this is ridiculous, as we all have to start somewhere, but any actual data is hard to come by. I know you're super busy, but your thoughts on this (or direction to a particular post where you discuss this - haven't read all your blog yet) would be AWESOME.
Best to you and thanks,

newFNP said...

TA - email newFNP at and newFNP will address your questions.

LP - newFNP works in practice with a family practice doc and her clinic has an agreement with a local hospital for deliveries.

Thanks for reading and commenting!