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Discussion

Guess what the ER doc did?

Hi, I am an ICU nurse in my local hospital, but I had to post my husbands visit to our ER here. I want you to please post on what you think the ER doc did, or should have done. Then I will tell you the outcome. This will be fun!

Ok, my husband is 2 years post liver transplant. He has Hep C, and was transplanted only due to a primary liver tumor, he has never decompensated. He is 56 and on treatment for Hep C with PegIntron and Ribavirin. Main problem during his transplant is strictures in the bililary ducts which required q3 month ERCP's for about 1 1/2 years to put in stents. The first time he had those done, he was in the hospital for pancreatitis. Fast forward about 11 ERCPs, and the last one he had put him back in the hospital with horrible pain, but not pancreatitis. So, a few weeks ago, he went back to have the stents removed. His hgb at the time was 9.1. Gastro not worried about this number. Ok, thats the history as short as I can tell it. He went to the big transplant hospital for all this. He did come home with oral cipro for three days. He never really felt well after this.

So, four days after stent removal, he develops a fever, chills, vomiting and diarrhea. I take him to our local ER, where the nurse got all his labs, started fluids and did all he could do. An hour and a half later the doc comes in. I told him the transplant doc wants a CT scan, and that he could call the gastro doctor there. He assured me that after all the tests come back, he would do just that. My husband was so sick, that I actually called the step down unit and told them he may be coming there. My hubby recieved dilaudid, zofran, and fluids, he was feeling good. Ok, labs came back at a hgb of 7.8 and a sodium of 127. His temp was 101.9 rectually. CT normal, heme neg stool, and only a trace of blood in his urine. ER doc calls gastro transplant doc, what do they decide?

Featured Replies

Maybe you should tell us what the ER doc did.......

Maybe you should tell us what the ER doc did.......

But then, the whole point of the thread (guessing what the doc did) and the fun, I might add, would be ruined!!!

not a nurse yet but.......

his hgb is very low there (from what i understand could be totally wrong). so transfuse and transfer either to the step down or icu?

The ER doc sent him home?!

I don't know, I'm guessing, blood cultures x2, more ns at a slow rate, a couple of units of prbcs, tylenol and more ABTs?

Don't keep us in suspense--what did they do?

What did they do.... ahhh this is interesting!

Sang a touching rendition of "The Star Spangled Banner"?

Lit the linen cart on fire? :chair:

ok, ok....two long days in the ER and I am stumped. But I am guessing along the lines of PAERRN20 with a dispo home.

he sent you guys home, huh?

Full admit to transplant unit. Were LFP tests within normal limits? If he was vomiting -- his antirejection meds may not have been at therapeutic levels. Hgb. 7.8 -- treat with 2 units prbcs . . . . Hyponatremia (Na

I'm really sorry if they sent him home.

The ER doc did not try to figure out what's causing the low Hgb and hyponatremia, possible infection and sent him home. What kind of hyponatremia is it by the way(hypervolimic)?

Sent him home with instructions to follow up with GI doc?

  • Author

I wish Transkat would have been the doctor! Ok, a couple of you were right. After consulting the Gastro doctor,(not the attending), the ER doc felt since there was no obvious signs of bleeding, that the blood test was flawed. So, he comes into the room and says, "Good news Bob, you are ok to go home." My husband is high on dilaudid, and is very happy. I however said, "WHAT! YOU ARE SENDING HIM HOME WITH A BLOOD COUNT THAT LOW?" Thats when he, in all his wisdom, explainded that something was probably wrong with the blood test. He said the gastro doc was more concerned about the sodium. I ask him why, since he was vomiting for two days? Anyhow, he left the room, and voiced my concerns to the nurse. She told me she was going to bring the doc back in. My husband, feeling like a new man, states"no, thats all right, if he says I'm ok, then I'm ok, I feel good." I informed him that it wouldn't last. Well, about 3am, guess what, he starts running a fever and vomiting again. I was going to call off work that morning, but he insisted he would be alright. No sooner then I got to work, his liver transplant nurse calls me and tells me to get Bob to the hospital, he is septic and needs admitted! OMG! By the time I got someone to cover me, got home, got Bob to the hospital, hours have passed. The same ER doc comes in fast, (do to my angry tone at the front desk), and asks me why I didn't get Bob there sooner! I looked right at him and said, "WHY DIDN'T YOU KEEP HIM?!!" Well, I didn't see him again. Bobs hgb was now 7, and sodium even lower. They found him a room fast, gave him 4 units of prbc to get his count up to at least a 10. Started him on Cipro, which was a waste because he has ECOLI in his blood. He came home with a PICC line and Iv antibiotics, and is ok now. Guess what me, the ICU nurse did? I won't keep you guessing, I wrote that doctor up! After the investigation, the Head Doc in the ER called me and said, "you husband was sent home on the ASSUMPTION he wanted to go home! I told him that is a stupid reason for an ER doc to send someone home. He agreed, the investigation continues..... Oh yeah, I called the Gastro doc, talked to his nurse, and she read his exact notes from that night, and the hgb of 7.8 was never mentioned.

My husband asked me what I want to come of this. I stated, "If that ER doc stops and looks harder at one transplant patient, or any patient, thats what I want." One last thing, the low blood count was due to the Ribavirin, not bleeding. He has stopped the Ribavirin, blood count is stable.

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