Had a post PTCA w/stent to rca pt this week that had a lrg retro-perit. bleed. They came back with lines out, and a Neptune patch. The site was cdi when it got to me no tenderness to flank, hip, or pubic region (none of which swelled much either), but had a very lrg hematoma to abd (VERY distended and firm). Gave blood, fluids, volume, etc, placed femostop for 4hours at sandbag. Next morning, she had Plavix and ASA ordered to give (last h& H had been 9.9, down from 10.1, color was better, pressors were off, fluids running at 50, and sbp stable and >90) so I called to verify, and was given the second order to give these, and get her oob by the covering md. That night her h&h was down to 6.7, so she got 2 more units of blood and I was given another order by another covering md for strict bed-rest and to d/c the plavix/asa. The next morning, the md that had done the proceedure came by and reordered the plavix/asa, and to get her OOB to chair (her h/h was back up to 9.9) , his logic being that we didn't want the stent to close, and we could just give her more blood.
I guess I'm just wondering what everyone else's thoughts are on the matter, because I had three orders, from three MD's, all with sensible logics (Bleeding v. Stent Closure), and This is the first I've run across this situation.
May 13, '07
dont want the stent to occlude do you. I would rather give blood and fluid until bleed controlled, what about surgical repair. I always tell me PCI"D gramma, don't stop taking the plavix