trauma tries to kill people, chapter 946

yet again, the trauma team demonstrates that its incompetence and lack of adherence to basic medical principles is alive and well.  and yet again, we have a patient that needs to be transfused who will be sitting on the floor, bloodless and half dead, until he is deemed "sick enough" for further intervention.

the patient is bleeding from multiple fasciotomy sites on his leg.  his H&H is 6.6 and 19, which is critical.  he's tachy at 140.  and we're just going to "watch him".  

you had better believe that if the intern told me this, i would have laughed in her face and went over her head.  but this is worse...oh much worse...as the decision to wait to transfuse until the patient becomes "symptomatic" came straight from the top.  allow me to list the problems i have with this.

1. look alive, people, tachycardia is a symptom!!  140 is bad, and if you think we're going to wait until he's taching along in the 160s to do anything about this, you're crazy.  i have no problem with calling a rapid response and getting a medicine doctor to give me what you won't.

2. this patient is going to the OR in the am for an orthopedic procedure, which will undoubtably require blood.  so what exactly is the issue here?  i understand that we don't want to throw a few units into everyone, but this patient NEEDS BLOOD.  he needs it now.  and if we wait until tomorrow, he will STILL NEED BLOOD, and we will be pissing off ortho and anesthesia by presenting them with a pale, ghostly, corpse-patient to operate on.  

3. this brilliant course of action (or lack thereof) was decided upon by the chief resident and attending,  both of whom presumably went to medical school and are not stupid.  more than one person thought this was a good idea?  i have 2 more names for my list of people who are not to touch me should i be hospitalized.  

this is where i'm going to get all clairvoyant:

tonight, this patient's tachycardia will progress to the point of instability.  he will become symptomatic, but this time with the "right symptoms" for transfusion, aka shortness of breath and chest pain.  he will be transfused with 2 units only when he is about to code, or as soon as he feels like he is dying, whichever comes first.  and then he will proceed to his surgery where he will receive an additional 4ish units, for a total of 6...maybe even 8.  

and everyone will continue to ignore the fact that the trauma surgery team makes poor, irresponsible choices until the next time that they try to accidentally kill someone.


***update***

the patient ended up getting 4 units of blood in surgery, and was then sent back to the floor with a non-functioning, leaking VAC.  so ortho is now dead to me too.