this week on my list of mortal enemies: the ER. the ER has certain habits that drive me crazy. for example, they frequently send their patients up to the floor naked, usually bleeding, and often with empty IV bags dragging behind them. so today when i got a stab wound to the chest from the ER, i was not surprised to find him pretty much as described above. the MDs had put in a chest tube, and i was taken aback when i saw that it had already put out about half a liter of blood since it was placed. i got the patient settled with another nurse and we pulled off the dressing that was leaking blood everywhere to put a clean one on.
still bleeding.
i called the doctor and told her how much blood was in the cannister...now about 600ccs. she told me to start fluids and she'd come see him. i did his admission.
still bleeding.
850ccs. paged the doctor again. she called back. now 975ccs. she said she'd call her attending and that we'd make him nothing by mouth for possible surgery. at this point the patient began yelling at me that he wanted dinner.
still bleeding.
the blood in the chest tube was now in the second chamber, so over a liter. vitals still ok. patient still yelling "i shouldn't have even come here" because i wouldn't give him his dinner tray. and finally, the bleeding seemed to slow down. 1130ccs. i took some vitals, and he was still ok. he fell asleep, and i let him be.
20 minutes later i'm (miraculously) seeing another patient when the doctor came in. apparently they had seen the patient and taken his blood pressure. 70/42. suddenly there was a sense of urgency. we needed fluids wide open, a type and cross for 4 units of blood and to get the blood right then then give it. all while getting pressure bags for the fluids and getting the patient hooked up to the dash monitor. um, not going to happen. i basically got as far as the fluids before the doctors started to yank the cords out of the wall so we could take the patient to OR. i managed to get one final BP in before that too got disconnected: 65/40. cue panic.
every once in awhile, the hospital really is like tv. and if i've ever felt like i'm on primetime, it was tonight as i ran down the hall towards the OR with a pressure bag in one hand and the other hitting the patient to make sure he was still alive. how we made it to the OR in one piece i will never know, but there i was under the bright shiny intimidating lights. the next thing i knew everyone was gowned and gloved and i was feeling very conspicuous. someone handed me a hat and mask, at which point i made my exit. frankly the OR freaks me out...way too clean and you can't touch anything in there...so that was that.
i honestly expected the patient to come back to the floor, but he got an ICU bed. when i took his belongings up, he was intubated and looked like a hot mess. and to think, 4 hours earlier he was stable enough to come to the floor.
so do i blame the ER for this? not really. they didn't really see the patient bleed all that much. and do i blame the doctor? she was actually pretty on top of things. and do i blame myself? no way, i rocked this one :) i kind of feel like this is just one of those things that happens...hopefully the patient will return to the floor no worse for wear and grateful that we helped him.
but for the records: it wouldn't kill the ER to throw a gown on a patient every once in awhile. sheesh.
No comments:
Post a Comment