Oh man, last night was "one of those" nights. We will start this from the beginning. Night before last I had cytotec induction. This was a perfectly healthy G2P1 with a beautiful pregnancy and no complications. Delivered vaginally the first baby and had no reason for any problems with this one (no real reason for induction either but that's neither here nor there :/). Got mom going, had a great night, beautiful strip, no issues. Started her pit at 0600 and with just 6mu/min she was in a beautiful pattern. 1-2cm/70/-2. I left thinking she'd be delivered before noon.
Get back to work last night and lo and behold she's still there but had just delivered at around 5. Get report that everything went fine she just kind progressed slowly. Only pushed for about 20 minutes but when baby came out, so did a large gush of fluid and baby was "shell-shocked" and needed to be bagged. APGARS 2/8. Baby doin fine now and breastfeeding "but watch cause he sounded grunty to me, nursery said no, but he did to me". Greeeeeaaaaat! Letting a grunty baby (that had a rough start an hour ago) breastfeed sounds just great. So I head straight to the room. Get in there with all 15 family members standing around, mom in the bed with her BLUE baby in her arms just as happy go lucky as can be. In my head i'm SCREAMIN "CAN YOU NOT SEE YOUR BABY IS BLUE!!!!" but instead politely say "your baby's color looks a little off, I'm going to take him to the nursery to check him out." and literally tear baby outta moms arms, all while trying to shuffle around the oblivious family members. I place baby in crib and haul a$$ to the nursery. Get baby in there and he is dusky/blue sats in the 70s, RR 120s. UGH..... Well the nursery nurses (bless their souls) took over so I could finish the recovery on the mom I most likely just highly offended by whisking her baby away.
So when I get back in the room I have the same 15 family members looking at me like I'm the devil. I told the parents I needed to speak with them about their son's status and told the other family members to go out to the waiting room (they were none too happy and giving me the evil eye but whatever. One even said " but we drove alllll this way to see the baby and you took him away" and i felt like saying " well, did you drive here to see an alive baby or a dead one" but i didn't.) So anyways, told parents what was up. They were cool with it after going through a million questions. Finally get mom up to shower and void and take care of herself so she can be transferred to her PP room which is what we did. YAY. Get all my charting caught up and check on baby who most likely has TTN. YAY again. Time to pee and relax a minute right? WRONG!
ER calls. Got a girl being admitted for postpartum preeclampsia with pressures 180/118 Mag bolus already started. Here's the kicker- She tested pos for opiates, benzos, and methadone. The rest of the story comes out that she was in a MVA last week at 36+ pregnant, abrupted, sent to another hospital with a broken knee, broken ribs. At some point they determined IUFD with abruption and delivered her vaginally. Yesterday was the funeral. When I get her up from ER she is as high as can be (they had just given her 4mg Morphine IV to top it off), with a broken knee in a stabalizer, wanting to get up and pee absolutely refusing bedpan or foley. get her to the bathroom (she actually didn't need much help) and then back in bed to pressures of about 150s/100s. Mag bolus finishes up so I start the drip. During this time all she wants to know is when can she eat, when can she smoke, and when can she leave. UGH AGAIN!!!! There were so many conflicting stories as to what was going on with this girl that I still don't know the real story. She had her d/c paperwork from the other hospital and it did show she was rx'd dilaudid and ativan, heparin, and Macrobid. Okay so that explains opiates and benzos. When asked about the methadone she played dumb and tried to say the CRNA must have given it to her. There are other holes in the story about the delivery of this IUFD and I saw somewhere in one of her notes where this is her 2nd abruption!!! I think we found the cause of her BPs and IUFD! Oh and her friend that was with her has also suffered an abruption. What's the luck, huh.
They say bad things happen in 3s. Can these count as 2? Oh and when I left today, the only 3 patients we had on the floor were all 3 on Mag. hahah What are your thoughts/ concerns/stories?
Nov 12, '12
That sounds like every night on my unit. 28 beds half labor and half pp. running to OR, not eating lunch, barely peeing..... I wouldn't ever dream of doing anything else though.
Nov 14, '12
You know looking back it wasn't even that bad. The addict was at least pleasant and was truly sick. I think i was just tired and needed to vent. And at least there were good outcomes for what I had. On a side note, last night my patients bbow exploded full of thin Mec and doused all of us in the room before we knew what was coming. I knew it would happen but it still got me lol. But we had a beautiful healthy baby minutes later