bloodbath

Sometimes I think trouble is drawn to me. It all started innocently enough. Another nurse asked me to come look at a patient with a VAC, basically a big suction dressing, that needed to be changed. She was concerned because the canister had gotten full suddenly, and wanted another set of eyes. We got a new canister, and I turned off the machine and clamped the tubing. As I was trying to attach the new canister, I heard a pop. My eyes immediately went to the leg with the dressing, which was suddenly pouring blood out onto the bed in spurts. I didn't really have time to do anything but react; I clamped both hands down over the bleeding to hold pressure and yelled for someone to call a rapid response. The blood was pouring out between my fingers, and the patient went unconscious. By this time, all of the floor RNs were in the room starting bolus fluids, getting vitals, and drawing labs. The patient's poor wife was trapped in the corner of the room, watching as he was bleeding out from his leg. After we put the head of the bed down, the patient started to wake up just as the rapid response team started arriving. The trauma resident on call was next, asking me to let go of his leg so she could see the site. She cut off the ace wrap and exposed the VAC dressing, which was bulging with the blood collecting underneath it. Someone mentioned the word OR, and the med student ran off to book a suite. The chief resident showed up then, and mentioned taking off the VAC dressing to see the wound itself. We all decided that this was a BAD idea and shared our concerns. He, of course, could care less about our opinions and decided he was taking the dressing off. At this point, I'm picturing what's going to happen when that dressing comes off (blood hitting the ceiling and the patient crashing come to mind), and I decided we had to go over this guy's head. In two years as a nurse, I've never called an attending. But tonight I was scared for our patient, so I DID call and (thankfully) the attending was at bedside in 5 minutes. Of course by this point, the dressing was off, the residents were suctioning out the blood with a yankauer, and the patient was screaming in pain. He started to shake as the doctors pulled away clots that looked the size of organs. Thinking back on it, I think he was starting to go into shock. Or maybe he just needed a little more than the 2mg morphine IV that the MDs ordered for pain. (Seriously, 2mg? Come on.) Once the wound was exposed, it was clear that there was bleeding (duh) and that he needed to go back to the OR (duh again). He was wheeled away and we were left to clean up the bloody carnage than remained...500cs in the VAC cannister, 150 in the suction set, and at least another 200-300 on the bed, the linens, and the floor. In a matter of a half hour, the patient must have lost at least a liter of blood. It was like nothing I have ever seen. Through the whole thing, our group of nurses was AMAZING. The whole ordeal went very smoothly, and I'm impressed by how efficient we were. Guess practice makes perfect :)