Bigger is not always better!

[ruralnurs]

I work in a small, 16 bed critical access hospital in NW Montana. Two weeks ago we had a 71 year old man present with low back pain. No chronic conditions, never been on meds, non-smoker, non-drinker, a hard working rancher (I actually graduated high school with one of his sons).

He had been helping to load a ditcher into the back of the truck when he felt “something” and then shortly began having back pain. The doc in our ER that night did x-rays and believed it was muscle strain, but as his pain radiated around to his abdomen, decided to do a CT (for a tiny critical access hospital we have some nice equipment).

He was in radiology and had just completed the CT and he crashed (45 minutes after he presented to our ED door), BP 50s/30s, gray, unresponsive. Got him back into the trauma bay and started working on him, our CRNA put in a central line and got him a bit more stabilized.

The CT showed an abdominal aortic aneurysm. And it was leaking. We called for the helicopter to the nearest larger hospital that does that sort of thing (75 miles away). The surgeon at that hosp took one look at the CT (we put it on-line) and refused to accept him “AAA way too close to the renal artery, I won’t take him.” The helicopter got there and we had to send them back.

We called a hospital about 200 miles away in Washington state and they said, “We don’t have a vascular surgeon, so we refuse to take him.” Called another hospital in that same town in Washington and they said “We don’t have an ICU bed to put him in after the surgery so we refuse to take him.”

So we had a man, dying, his family all around him and all of these places refused, they simply refused, knowing he would die without surgery. Our general surgeon, who does hysterectomies, gall bladders, appendectomies, tonsils, etc. Looked at him and his family and said, “You are dying, I am all you have got and you will probably die on the table.”

The family agreed and we took him to surgery. He got 7 units of PRBCs, 2 units of FFP, a dose of hetastarch and gobs of fluids. We saved his life; he walked out 10 days later.

Just had to brag about our little hospital. This kind of shows what nurses in rural facilities have to deal with too. We have to be able to respond to and help with anything, MVCs, med/surg pts, helping to deliver a baby, etc.

Bigger is not always better!

[WoofyMutt80]

I give kudos to your hospital! And to the other hospitals that turned that pt down I got to ask "What the French Toast??"

[oramar]

You are right to brag, big pat on back to all of you. Shame on those people that would not help.

[FireStarterRN, BSN, RN]

That is awesome, thanks for sharing! Great story!!!!

[twinner2]

Kudos to your surgeon, staff, and hospital! Congrats on saving this man's life when the big boys were too scared to play!

[Spritenurse1210, BSN, RN]

I work in a small, 16 bed critical access hospital in NW Montana. Two weeks ago we had a 71 year old man present with low back pain. No chronic conditions, never been on meds, non-smoker, non-drinker, a hard working rancher (I actually graduated high school with one of his sons).

He had been helping to load a ditcher into the back of the truck when he felt "something" and then shortly began having back pain. The doc in our ER that night did x-rays and believed it was muscle strain, but as his pain radiated around to his abdomen, decided to do a CT (for a tiny critical access hospital we have some nice equipment).

He was in radiology and had just completed the CT and he crashed (45 minutes after he presented to our ED door), BP 50s/30s, gray, unresponsive. Got him back into the trauma bay and started working on him, our CRNA put in a central line and got him a bit more stabilized.

The CT showed an abdominal aortic aneurysm. And it was leaking. We called for the helicopter to the nearest larger hospital that does that sort of thing (75 miles away). The surgeon at that hosp took one look at the CT (we put it on-line) and refused to accept him "AAA way too close to the renal artery, I won't take him." The helicopter got there and we had to send them back.

We called a hospital about 200 miles away in Washington state and they said, "We don't have a vascular surgeon, so we refuse to take him." Called another hospital in that same town in Washington and they said "We don't have an ICU bed to put him in after the surgery so we refuse to take him."

So we had a man, dying, his family all around him and all of these places refused, they simply refused, knowing he would die without surgery. Our general surgeon, who does hysterectomies, gall bladders, appendectomies, tonsils, etc. Looked at him and his family and said, "You are dying, I am all you have got and you will probably die on the table."

The family agreed and we took him to surgery. He got 7 units of PRBCs, 2 units of FFP, a dose of hetastarch and gobs of fluids. We saved his life; he walked out 10 days later.

Just had to brag about our little hospital. This kind of shows what nurses in rural facilities have to deal with too. We have to be able to respond to and help with anything, MVCs, med/surg pts, helping to deliver a baby, etc.

Bigger is not always better!

Hey, you guys did a fantastic job. great going! it just proves that if the hospital and staff know what they are doing, it really doesn't matter what kind of hospital you are. the goal is to ultimately give the patient the best chance for survival and quality of life! *big pat on the back and hugs!*

[Purple_Scrubs, BSN, RN]

Hooray for all of you! I give the surgeon tons of credit for not putting his risk of malpractice before patient welfare. :bowingpur:bow::bowingpur to all of you!

[Dorito, ASN, RN]

Rock on! The little hospital that could! Great Job!

[nerdtonurse?, BSN, RN]

:clphnds:

Ruralnrs, you guys could look after me any time! Awesome job!

And dang but I'd have to call those others and say, "well, we won't need the bed, WE SAVED HIM."

[NC Girl BSN]

Great Job! That is something to brag about!

[PacoUSA, BSN, RN]

What a great feel-good story, thanks for sharing!

[Straydandelion]

Wonderful story, I can understand the first two hospitals if the surgeon doesn't feel competent (even though I am sure yours didn't either) but not the third, surely something could have been done about the ICU bed???