Lowest H/H I ever saw... - page 4
...was on a post gastric bypass reversal. Worked with her all night, vitals stable as a rock. Feelin' fine, SaO2 99% on room air, SR 78, BP 120's, tummy soft, minimal pain, minimal serosang... Read More
May 19, '05Occupation: nurse and sexual health educator Joined: Jan '04; Posts: 113; Likes: 6female, adult, HIV + who WALKED into clinic stating she felt 'really tired'- was on AZT- H&H of 3/6. sent her to the ER for a transfusion (and switched the AZT portion of her therapy!). she did great.
May 19, '05Occupation: ER RN Joined: Mar '05; Posts: 476; Likes: 20Quote from Jen,SNHGB is usually about 1/3 of the crit...so you can guestimate that it was probably about a 12 to a 7 drop....That is a lot in 3 hours...Had a patient the other night go from a crit of 37 to 22 in 3 hours--not sure what the hgb was. Upper GI bleed. between vomiting and the NG tube, we got 1400 cc of blood out of her stomach before sending her to the unit. Last BP on the floor was 48/??. One of the other nurses saw her being RAN into the OR an hour after we sent her to the unit.
Jun 5, '05Specialty: Critical Care/ICU ; Joined: Aug '04; Posts: 1,298; Likes: 73Had an admit from the floor to ICU at shift change this am. Whew! This patient KICKED MY BUTT!
When they found him in respiratory failure (actually near dead) with a systolic of 56 at 7:15 am! (did no RN look at this guy all night - docs found him on their rounds!), they began resuscitation while preparing to transfer to us. Hct at 07:20 was 24.8. When I sent labs at 08:00 his hct was 16.4/hgb 5.2! That's more than an 8 point drop in less than an hour. I suppose that some of that was dilutional, but when I sunk an NG he put out a 1200 mls of coffee grounds in about 10 minutes (later, I suctioned this same coffee grounds from his lungs too :angryfire ). His sugar was 34; abg: ph 6.18; Co2 120; po2 62; bicarb 4.2! Talk about lowest values!
Liver ca, end stage. Poor fellow. No one could get a hold of his family, he was a full code (no compressions were done) who was coherent and awake the evening before. This guy's belly doubled in size right before my eyes. They were doing everything - intubated, lined, pressors, ffp, blood, fluids, bicarb, after bicarb, after bicarb, after bicarb and D50. He was coagulopathic too and COLD! We couldn't get a temp.
I worked over for 4 hours to admit this guy this morning. I can't believe I drove home - I was absolutely exhausted, but the docs were such a pleasure to work with - they knew I was pulling 16 hours. When the Attending arrived at about 9ish, he had his chat with his Residents and Fellow as I listened, busily rushing around doing crap and then he turned to me and asked if I had anything to add or any ideas, or do I need anything, and not to worry about the swan and continuous cardiac output set-up until I'm ready. I just can't explain that feeling of validation and respect when you feel that you're about to fall flat on your face.
Patients like this really break my heart. He was relatively young too. The thing that REALLY bothers me is that this patient was transfered to us from a monitired unit. So sad.
Wait. What was the topic of this thread? :chuckle
Good to get all of that out.Last edit by begalli on Jun 5, '05
Jun 9, '05Joined: Mar '99; Posts: 13,361; Likes: 1,376[QUOTE=
I know I still get cross-eyed though when I read "2L NS wide open"[/QUOTE]
I often care for CHF/pulmonary edema so was SO nervous caring for a burn patient. They need SO MUCH fluid!
OK - back to topic -
Years ago we first met a young mother with sickle cell. Her H&H was about 4/12 when she was admitted for transfusions. In the morning I helped her to the bathroom (I was then working M/S). Whe she rang to go back to bed she looked healthy, no anemic. She did it with make up. I couldn't imagine how she had the strength. She worked full time almost until dying in her forties.
This lady was our patient from the time her son was four until she died in our CCU the summer after he graduated college.
Jul 3, '05From: US ; Joined: Jan '04; Posts: 268; Likes: 103Quote from JJRNWhat does the birth control pills do ............sorry only 6months experience as RN not sure how birth control pills help with the low H/HHct 2 Hmg 7...22y/o Jehovah witness...bleed out from scalp lac p rolling a Ford Explorer(other injuries easily manageable) Weeks on vent...epogen...iron...birth control pills. With lab draws qod, her blood literally looked like Hawaiian Punch. She walked back in months later and looked great.
Jul 3, '05Specialty: NICU ; Joined: Nov '03; Posts: 3,768; Likes: 252Quote from angelique777The Pill makes you have regular cycles that tend to be much lighter than what your body would do naturally. Some women actually get anemic just from having a monthly period! I actually knew someone who took a Pill that had iron in the placebo pills to give her a little boost.What does the birth control pills do ............sorry only 6months experience as RN not sure how birth control pills help with the low H/H
But in that particular story about the Jehovah's Witness woman, I'm guessing they kept her on the active Pills nonstop to prevent a period from even occurring, to limit any kind of blood loss.
Jul 3, '05Joined: Jul '05; Posts: 25Quote from angelique777Birth Control Pills regulate menstrual periods and decrease blood loss during that time. I'm sure this pt was on them so that blood loss during her period did not add insult to injury.What does the birth control pills do ............sorry only 6months experience as RN not sure how birth control pills help with the low H/H
Jul 3, '05From: US ; Joined: Jan '04; Posts: 268; Likes: 103Quote from LadyStormBirth Control Pills regulate menstrual periods and decrease blood loss during that time. I'm sure this pt was on them so that blood loss during her period did not add insult to injury.
Totally had my mind on my own patient who is a JEHOVA WITNESS with similar problem except she is like in her 70's (no menses here lol) just totally was not thinking about the patient menstrual cycle .. lol thanks
Aug 18, '05Joined: Nov '04; Posts: 6; Likes: 1the lowest i have seen was <1 on hgb. came into the icu from er with 2 triple lumens in and blood infusing in 2 ports, ns infusing in 2, platelets also infusing, and dopa. All labs were out of wack wbc over 100. got a phone call from lab saying abnormal rbc's was worked up and diagnosed with leukemia.
Aug 18, '05Joined: Oct '03; Posts: 25; Likes: 12/12. Amazingly enough, I was working ER and noticed that the 8 month old brother of the ER patient looked way more ill (white as paper) than the sister that didn't even belong in the ER. Convinced the parents to check in the baby and found him to have the HH 2/12. He was starflighted to the nearest pedi ICU with a scalp vein (that I started) and blood infusing. Turns out that he was extremely malnourished. Parents had been diluting formula and so on. The ER doctor later said it was a good call as she hadn't even noticed the baby since she was focusing on the sister. Sometimes it pays to be aware of your surroundings. Needless to say CPS was involved on that one.
Aug 18, '05Occupation: Certified Registered Nurse Anesthetist Joined: Jun '04; Posts: 470; Likes: 27Had to take a GYN patient back to the OR a few months ago...H&H was 2 and 7. She lived - thank god she had no CAD.
Jan 25, '10Joined: Dec '05; Posts: 989; Likes: 438i know this thread hasn;t been updated in a while, but I had a pt come in to the ER the other day after MVA vs tree. pt was a 26yo 9mo pregnant female who presented with unresponsiveness and soon was coded. After an emergent C/S and receiving 7 units of blood and 6 units of NS, her HGB was 1.3!!!!!!!!!!!!!