i have never before watched someone lose so much blood from rectal bleeding as i did tonight. 725ccs in 3 hours, 3/4 of a graduated cylinder of frank blood with clots. terrifying and shocking.
the problem lies in the treatment, which is wait and see, or as i like to think of it- record and stalk. every drop of blood, every cc of urine, all the vitals. watching the labs, watching the heart rate and blood pressure like a nurse nazi, that is the plan. unfortunately, i feel that i know the outcome of this, and it makes me anxious.
this man will tank. drop like a rock. be fine until he isn't fine and we're scrambling to bolus and transfuse and get in there to find the bleeding and stop it. there will be an urgent ICU transfer, or a trip down to the OR with an ambu bag in one hand and a pressure bag in the other.
***
i could not take the feelings of impending doom, so i do what i often do and call the night nurse from home so i can sleep in peace. as he has now lost about 900ccs of blood, the patient is going to the ICU. soon he will be covered in a bajillion monitors that will not let him slip into hypovolemic shock unnoticed.
and with that, i can relax. and add massive rectal bleeding to the list of crazy/weird/gross things that i've come across.
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