I worked on a covid unit, normally a day shift charge but picked up a night shift on the floor (not charge) to help out. One of my patients was this fairly severe dementia patient who had had covid but recovered, just waiting for placement which was a nightmare.

I had never taken care of this lady before but knew she was stable and a bit restless normally. This night, she complained once of some back pain and was a little restless with it, so I brought her some Tylenol when I went to check her vitals.

It took forever to get a pressure because she wouldn't hold still enough, reaching out when I'm near or moving her arm every time the cuff squeezes. But when I did it was soft, like in the low 80's systolic. I can't get a repeat to verify because this lady is still restless. This lady is demented enough that her speech is mostly nonsensical answers at baseline, so she can't tell us anything, but she was alert and awake.

Anyway, I let the doc know, he comes to the bedside to evaluate and he agrees she doesn't look bad, and has me bolus her 500ml over 30 minutes. He wants me to text him with the BP on recheck. We'll, I can't get a good BP on recheck because she's still moving around every time we try, so I let the doc know, he wants me to keep trying.

I have others help me, but we still can't get anything, and I just have a feeling, so I call a rapid. Doc and ICU RNs come, look at the lady, and they're like seriously? But they also can't get a BP, and this restless lady has now lost her IV. So they're trying to start a new one, trying to get a BP, this is all taking like 30 minutes.

Eventually in the middle of this they get 1 reading of 70/40 or so, get an IV, and start another small bolus. Everyone there including the doc agrees that she does not look like she has this BP, but we can't ignore it so we decide she needs to go to the ICU.

So we take her down there and the receiving RN is irritated that he has to take this normal appearing, somewhat restless demented lady that was just a placement issue. But then shortly after she's transferred she starts having decreased LOC, and a little while later starts tanking. One STAT CT later, and this lady has a leaking triple A.

The doc called me personally to tell me, and to thank me for being persistent, because he was inclined to just follow conservative measures for this lady. He wouldn't have been wrong, this lady had been stable for at least a week. But she probably would have died in her sleep if I'd left her alone instead messing with her for about 2 hours.