Maternal death

  1. What they don't teach you in nursing school.
    We had a maternal death the other day. I wasn't there (thank god) Although I am asking tons of question so i can be prepared if and when it happens again (I work in a level 3 facility so unfortunalty chances are it will) Well turns out our hospitalized known previa started bleeding over 2 liters in about 10 minutes. Well that previa turned out to be a procreta (where it is an acreta but it keeps growing into, through and into other organs) they could not stop the bleeding. Our docs, three or four anethesiaologist and an OR tem from the main OR worked on this lady. Anyway this prompted me to ask question like (if this were to happen what do I do what steps, in the OR do I skipp) My reply was pretty much follow the docs lead. Get the lady to the OR table make sure she has a foley and the doctor has a knife. One of the other nurses had a question for the anesthesiologist about what if she drops something the reply pick it up off the floor and give it to me.
    They dont teach you that in nursing school!!!!!!!!!!! They teach you to always do it the right way the "clean way" the "sterile way" Sometimes in thankfully rare cercumstances it just has to get done. You drop the only A line insertion guide you have (don't even know if that exsists made it up) but this ladies life depends on it. You drop it if you wait to get a sterile one she is dead you put the dirty one in and hope she survives. Sometimes i wish a true emergent maternal code is caught on tape not so I can be that icky person that wants to watch gore or dead but so I can watch what everyone does in it so I can learn so I can be prepared when it happens again.
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  2. 11 Comments

  3. by   Justhere
    Sorry to hear this. Don't know if anyone is ever prepared for their first code. You just have to jump in and do the very best you can for your patient and pray for a good turn out.
  4. by   TrudyRN
    I was taught to not stand on ceremony in a dire emergency. We can always fight infection later. Right now we have to cut and do the surgery and start the IV's, etc.

    Things to skip: scrubbing, prepping, anything the doc wants to skip; I guess I'd have to draw the line at using dirty, used instruments unless they were absolutely the only available instruments. But that's why OR's keep sterile trays ready.
  5. by   elliebellie
    How tragic for your unit Hopefully there will be some kind of debriefing where the people involved can talk about what went well & what didn't. My unit has taped simulated emergencies where it can be watched later & discussed.

    Sometimes no matter how much you plan or how "perfectly" it goes during the case, you still have an unexpected outcome. I am so sad for your unit and the family...
  6. by   SmilingBluEyes
    I am sorry this happened. I do hope you all had an opportunity for counseling after this. This is a horrible and traumatic event for all involved. PTSD happens often to health care providers in such cases. Please take care of yourself as you reflect on this situation. Learn what you can from it, but please, do not neglect your own needs in the process. I am so sorry, again. What a tragedy for that family and the staff.
  7. by   flytern
    Be prepared! This unfortunately is part of the deal of working OB. At least once a month we have mock drills on different situations, post partum hemorrhage, infant abduction, seizures, prolapsed cords....
    Hopefully, you work in a unit where everyone pitches in. Do you have an OR in your unit? If so, go into it every once in awhile, get familiar with instruments.. Have your scrub tech go back with you, they are a fountain of information, tap in to it. Talk to the doctors, anesthesia, RNs with more experience.

    A dirty instrument is better than no instrument, that's what antibiotics are for.

    Needless to say, document, document, document. Not that it will bring back a mother, but it will keep you out of court.

    :spin:
  8. by   BSNtobe2009
    Quote from TrudyRN
    I was taught to not stand on ceremony in a dire emergency. We can always fight infection later. Right now we have to cut and do the surgery and start the IV's, etc.

    Things to skip: scrubbing, prepping, anything the doc wants to skip; I guess I'd have to draw the line at using dirty, used instruments unless they were absolutely the only available instruments. But that's why OR's keep sterile trays ready.
    As a pre-nursing student, this was an incredibly insightful post, and it's something that you don't think about until the opportunity presents itself. It's easy to forget that young, healthy women still die in childbirth, and it's really something everyone needs to think about.

    I'm a single mother, and I even had a plan in place in the event of my demise when I had my daughter...because I was so afraid of what would happen if that decision was left up to someone else.
  9. by   SuperFlyRN
    Our unit started Emergency Drills about one year ago and they are fabulous! They are spontaneous and very realistic and, IMO, a very effective teaching and training tool. Our program director started the drills after a very unfortuante DIC a couple years ago.
  10. by   mitchsmom
    I can be that icky person that wants to watch gore or dead but so I can watch what everyone does in it so I can learn so I can be prepared when it happens again.
    If you have been involved in a bad one, you'll probably take part in a root cause analysis where everyone does that - go over what went right, what didn't work, what can be done to make it better next time. Most of our hangups were logistical things - knowing where unusual items were; clarifying who calls who/when, etc. Watching that kind of thing does help for future emergencies - pilots do it all the time, to learn from prior crashes and avoid future ones.
    Last edit by mitchsmom on Jul 12, '07
  11. by   mitchsmom
    Quote from flytern
    Be prepared! This unfortunately is part of the deal of working OB. At least once a month we have mock drills on different situations, post partum hemorrhage, infant abduction, seizures, prolapsed cords....
    Hopefully, you work in a unit where everyone pitches in. Do you have an OR in your unit? If so, go into it every once in awhile, get familiar with instruments.. Have your scrub tech go back with you, they are a fountain of information, tap in to it. Talk to the doctors, anesthesia, RNs with more experience.

    A dirty instrument is better than no instrument, that's what antibiotics are for.

    Needless to say, document, document, document. Not that it will bring back a mother, but it will keep you out of court.

    :spin:

    :yeahthat: !!!
  12. by   CHATSDALE
    hospital where i was working the ob was on same floor separated by long hall..one of those nurses can over to try an contain composure..a young mother was leaving for home when in the elevator she threw a pul emb and slumped over in the chair..the cna and the husband were right by her side and they summoned help but she didn't make it sometime life is so fragile
  13. by   cookiecuc
    What do you do when you have a situation like this? How do you prepare for something like this if you have never encounter sonething like this?

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