A patient was admitted one evening with a week’s worth of symptoms consistent with severe enteritis, including severe diarrhea, crampy lower abdominal pain, nausea, vomiting, and lightheadedness. The patient also developed an acute kidney injury as a result. After overnight hydration, the patient’s kidney function improved, but the nurse noted significant tachycardia and dyspnea with minimal exertion.

She reviewed past medical records and discussed the case with fellow nurses. After discussion, she was convinced of an acute pulmonary embolism. She initially spoke to resident physicians about her concerns, but when they seemed less impressed, especially since he was chronically on an anticoagulant, she reached out to me via Teams. She was frank, prompt, and decisive as to her concerns. Her concerns were spot on! His creatinine had improved to a safe level to get a CT chest with PE protocol.

He was found to have a very extensive sub-massive pulmonary embolism. He was treated and dramatically improved over the next two days and was discharged three days later. Not recognizing acute sub-massive pulmonary embolism certainly could have resulted in the patient’s demise. In conclusion, this nurse, aided by fellow staff, acted confidently, concisely, and promptly to help us establish a life-threatening diagnosis that was not apparent upon admission, resulting in a most excellent outcome. Death could have easily been the outcome without her proactive and confident thinking.

She and all the nurses working that day deserve a “shout out” for work above and beyond the high standards expected of a VA healthcare employee. Job well done!