The other day I had a situation that really frustrated me. Patient was in our unit overnight until endoscopy the next day with massive amounts of frank blood in stool with a whole lot of clots too. We were transfusing blood all night and the patient was maxed on a vasopressor at times throughout the night when she would bottom out. Urine was adequate but Cr was rising. Patient had crackles occasionally, but in general, despite old age and cardiac history was tolerating the blood.
I felt like we should have bolused the patient and verbalized this vehemently many times. Even 250 ccs would be something. I dont see how using a vasopressor to starve the end organs to vainly attempt to hide the problem of hypotension by clamping down tubes that have no volume in them will help this patient.
I wanted to call the primary because I couldnt get through to the GI doc but the charge nurse was very aggressive and confrontational when I proposed a bolus, and in calling the primary.
I know Im new, but we've bolused patients with a lot more respiratory compromise than that because they really needed it. We've bolused anuric patients without an airway for christssake. This patient had neither renal failure or pulmonary edema at the time.
It was just so frustrating to me because it makes no sense to me to continue on course with a severely widened pulse pressure with critically low diastolic maxed out on levo without bolusing the patient. Especially when her bp was dropping to the 40-60s on levo! I just cant wait till I am an old timer and people wont completely disrespect me when I propose a solution and I can call the mds without charge nurse approval. It really gets me going to know this patient suffered all night (and her kidney's too) because the gi doc didnt want to do an endoscopy at night.
What would you have done in this situation. Do you think I should have also avoided the use of bolus based on the info I gave? Thanks for the advice in advance :)
