Doctor Asked For A "Kind" Nurse - page 15
Let me preface this thread by stating a few things: 1. I'm not posting this thread to bash certain religions, I'm posting to vent, gain understanding, and get a variety of views. 2. Whatever... Read More
Mar 27, '03Sorry to hear today's news. It is sad and tragic. Keep your chin up - you are doing a great job!
Mar 28, '03This post may come a little late....
Vegas - Why is pt a full code (crash cart at door)? I would have a problem with that. I presume supplemental O2 in use - Ativan and MSO4 to calm pt and reduce O2 needs. My heart goes out to you at this time. Being the nurse when a patient bleeds out is very difficult.
HBOC can be used in limited circumstances - but generally used when you know that the bleeding can be/has been stopped, and when you know that you can back up with blood products if needed. You can only use limited amounts of it and must know that the pt will produce cells on own or blood loss has stopped. Otherwise, it is usually a brief fix.
We need to increase funding for blood substitutes and bloodless medicine for many reasons.
Blood products are increasingly in short supply. With the deployment of troops in the ME, we have lost a major group of healthy donors for a time period - as they will be prohibited from donating for a time period upon return. Much of blood supplies will be required for their care and those of allied forces. Of recent concern, many European blood supplies and donations of those that may have traveled in Europe during certain time frames - d/t fears of blood contamination d/t "mad cow"/Jakob-Crutzfeldt(?) disease, which can remain dormant in the body for extended periods of time.
Drugs such as Neumega (increases platelet counts)are incredibly expensive and frequently not covered by most insurances. And if you can't keep the patient from bleeding, they will continue to need PRBCs.
Onco patients often require repeated transfusions of all blood products - a major problem is that they become "refractory" to PLT transfusion. Their systems get so sensitized to the "foreign" platelets that their bodies will destroy the transfused platelets/stop producing platelets - so despite transfusions, the levels drop even faster. These pts require HLA matched platelets - even harder to come by. A bloodless alternative would be immensely helpful.
Many of the antivirals and their technology comes from research into AIDs. This technology has gone on to help plenty of non-AIDs patients. The research into bloodless medicine could help many patients other than JW patients.
Mar 28, '03Originally posted by fab4fan
BTW, everyone benefits from the advances that have been made in bloodless medicine/surgery. I think most medical professionals agree that there are risks with transfusions, esp. now. Just as we understand the effects of indiscriminate use of abx., blood is now being seen as not the "only" option.
While many get frustrated with pts. who refuse blood, bear in mind that their steadfast refusal has resulted in doctors exploring and refining alternative treatments that benefit everyone.
Mar 28, '03Hi Vegas I hope your patient makes it through
and I think the Dr. did find a good nurse, because you care
I just have to say youve done a great job explaining things, I dont think I couldve done a better job. (JW RN student__>thats me!)
I heard from a JW ER nurse of a case of a man who died from rejecting transfused blood (his type of course), and she believes he would lived if he was a JW.
The man had his legs partailly cut off in a car accident and his femoral ateries were severed.
She said if he was a JW they would have just cut his legs off, stopped the bleeding and saved his life but not his legs.
Instead they tried to save his legs, gave him blood and he died from his body rejecting it.
I know this was a bit off topic and a very different story, but I just thought maybe it woould help to give a differnt perspective.
Oh yes, I think non blood managment can help EVERYONE not just JWs.
No more worrying about if the blood supply is low
No wrry about rejecting it ect
just my 2 cents of course
Mar 28, '03Wow! What a thread! I have learned alot--many thanks to fab4 and Vegas and everyone. This may be a day late and a dollar short, but several days of posts ago, people were posting about rods and staffs and discipline etc. FYI:disciple and discipline come from the same Latin root, discip--"to grasp". Cool or what?
fab4: I truly hope my anecdote about the post partum pt was not perceived as a bash. Our ICU staff just couldn't get this pt to understand that w/ a hgb at 4 and dropping that breastfeeding wasn't an option. I do understand her conflict, but the body has finite physical resources. I didn't tell the story to make a blanket statement about JW's; it is my only interaction with JW's in an acute medical crisis. Sorry if it came off wrong.
I would be extremely frustrated and saddened by the situation Vegas is in. However, I know that I would want treatment that reflected my own value system (and to be at least nominally incharge of tx) and that I would need professionals around me who could meet me where I was, so to speak. That IS our job--and often it is the hardest part of that job. I commend Vegas--she sounds a great nurse!
Mar 28, '03liberalrn: No, I didn't take it that way at all. I treid to PM you, then I remembered that you don't have "PM" enabled, so then I was going to send you and e-mail, but something else diverted me and I forgot...so anyway, fuhgedaboudit!
Nessa1982: I'm going to send you a PM
Mar 29, '03
Mar 30, '03Originally posted by leeca
Docs prefer to use blood because its cheaper.
Mar 30, '03Originally posted by lgflamini
Wrong. They prefer to use it because it's more effective.
1. Bank blood does not have O2 carrying capability for 24h, so essentially, you are just replacing volume.
2. Doctors tend to use blood first because that is what is familiar. When they cannot use blood it forces them to be even more aggressive in tying off smaller bleeders that they could ordinarily let go if the pt was getting blood. It also forces them to utilize other lesser known (yet very effective) non-blood alternatives.
Mar 30, '03Deneen, I'm sorry to hear how rough this has become for you. I'm thinking of you often. (((((Vegas)))))
Mar 30, '03Originally posted by caroladybelle
Vegas - Why is pt a full code (crash cart at door)?
Thank you, everyone, for your support and good wishes. I'll give an update tomorrow.