Bleeding patient

[javajunkie]

OK, I need some opinions:

Last night I admitted a patient with a lower GI bleed. Basically, I knew I was in trouble when the ER "called report" by saying that they were bringing the patient over and giving me report in the unit (always a bad sign). Anyway, the patient arrives, rapid infuser in tow. For the next 8 hours, this patient produced bright red blood from his rectum at about the rate I was giving it. After recieving packed cells, fresh frozen plasma, cryo and a whopping dose of DDAVP, I questioned our goals with this patient. It was explained to me that this man needed angiography but the radiologist refused to come in. So we continued on our quest to deplete the blood supply. In an act of desperation, we called the GI attending to do a scope. He arrived within 30 minutes and of course, couldn't see a whole lot around the river of blood. We talked him in to calling the radiologist himself to explain the need for angiography. Still he refused, but agreed to come in a whole hour earlier than he planned.

Long story short, this patient received 28 units of PRBC's, 12 units of FFP, 5 10-pack's of platelets, and cryo before finally being admitted to the angiography suite.

So, here's my issue: I don't have too much of a moral problem with depleting the blood supply. Secondly, I really don't mind being at the bedside of a patient and doing the work required to keep that patient alive. What I DO have a problem with is that the best interests of my patient came second to the warm bed of a radiologist.

I really feel like discussing this situation with our medical director. I am fairly certain that even if my patient survives surgery, he is going to have quite a battle with DIC and most likely ARDS. Perhaps some of that could have been prevented with promt treatment.

I would like to hear from anyone who has been in a situation similar to this or anyone who would like to share an opinion.

[ratchit]

Having been a radiology RN, I am not surprised. Radiologists have one of the cushiest jobs among docs. The ones at my last job set up a teleradiology service- regular XRays that had to be done at night were read by the residents or the ER doc. CT's were transmitted to some company in the midwest, who read them and faxed them. Before the telerad service was set up, scans had to be approved by a rad- who could read them from home. After the telerad service was set up, any scan could be ordered stat by anybody- which called a tech in for stupid things all night. But since the teledocs read it, our docs could sleep nice and cozy. Can't even page them after 7pm.

We did have an angio doc on call, but they never got called in. GIB's were turfed to the GI doc, who was great about coming in when necessary. Real vascular crises could go to the OR or to a bigger hospital.

I'm sure there are some good ones, but the rads I have worked with were a bunch of "not going to lose sleep or get my hands dirty" prima donnas.

Talk to the director and with the GI and admitting attendings- this definitely affected patient care.

[LilgirlRN, ADN, RN]

Can you imagine a column in the newspaper with the names of doctors who refuse to come in and do what they took an oath to do?

[Rapheal]

Some people become doctors because of the money and status. They have no altruistic notions in their sad little lives.

What is sad is that many kind, caring medical professionals treat this kind of doctor's behavior with apathy, enabling them to get away with it.

My advice- talk to your medical director. You have a conscience. The doctor does not. Do it for yourself - do it for your patient- do it for your profession. You might not get anything changed, but you will at least not be a part of the problem.

[javajunkie]

Well, as I suspected, this patient's mortality has increased exponentially. When he finally got to the OR, he dropped his pressure to about 30 systolic when put under anesthesia. After some chest compressions and a total of 10 more units of cells, some more platelets and FFP in the OR and a 5 hour colon resection, the patient was "stabilized." So now he is not bleeding, but his body has to deal with literally hundreds of people's germs. I am shocked he is not in DIC or ARDS (yet).

I have an appointment with my medical director today.

[nowplayingEDRN]

javajunkie.....

You go!!!! That patiet's care was seriously conpromised and treatment was delayed because that lazy bum would not get his buns outta bed! Because of that the pt was almost lost on t he table. He is most fortunate that he has not gone into DIC or ARDS.......Nursing needs more patient advocates.

[butterphlyrn]

Wow, I thought that stuff just went on at the hospital that I worked at. Our ICU does medical and surgical. On friday we had a patient who had a CABG. He made it to our ICU bed to recover. Immediately upon getting to the roomhe went into v-tach. We shocked him, did CPR and he started pouring blood into his two pleuravacs, immediately he lost 4 liters of blood

This happened at 1100. We called the surgeon who seemed put out because he hadn't eaten but he came up. We ended up cracking his chest right there in the room. Got the OR team to come up and bring the cell saver so what was pouring out of his chest we could give back to him amongst the other 30 units of blood products that needed to be given. We had blood on the rapid infuser, the internally shocked him multiple times. Finally they were about to place a IABP and we got a pressure back. The doctors yelled pack him up we are taking him to the OR. We lost his pressure again preped him for the IABP, we got a pressure back 70, sent him to the OR and he had another 5 hours to repair the tear in his aorta.

The Surgeon later said thank goodness it happened when it did because if it happened in the middle of the night he would have been dead before you could have talked any of us into coming in.

All they ever say is that the patient is coagulopathic give FFP.

Well to our surprise the patient lived and the first day post op was extubated. Well guess what the second day post op, the patient went into ARDS.

[Geeg]

Go javajunkie, you are a real pt advocate. The other person who should be called on the carpet is the blood bank doc. A light should have gone on over his head also, gee, we are using alot of products here, what the hell are they doing. Or better yet, not doing.