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.
Specializes in Management, Emergency, Psych, Med Surg.
GREAT JOB!!!!! I have worked in a small emergency department and I know how it is when you have someone dying and you can't provide the service. But what ever you guys did, it was the right thing. This guy has classic symptoms of a AAA. It was good that the physician investigated further. Always assume the worst and hope for the best.
doesn't it feel awesome when someone on death's door makes it (thanks to your interventions)?
In defense of the "Big Boy" Hospitals (sounds like a restaurant chain, huh?)
we've had surgeons accept some sick as $*** patients who were basically dead when they got to us. I always wonder if the patient REALLY wants to spend their last few hours getting poked/prodded/intubated, or being surrounded by family who love them.
And maybe I'm just surly from working all night, lol.
leslie :-D
11,191 Posts
and now this fine surgeon can advertise, "we now do aaa's......yay US!!!!
leslie:balloons::balloons::balloons: