Guess what the ER doc did?

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Specializes in Critical Care.

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?

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Specializes in Med/Surg, Ortho, ASC.

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

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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!!!

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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?

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Specializes in ER.

The ER doc sent him home?!

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Specializes in acute rehab, med surg, LTC, peds, home c.

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?

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

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Specializes in ER, education, mgmt.

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.

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Specializes in Acute Rehab.

he sent you guys home, huh?

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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.

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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)?

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Specializes in Cardiac Telemetry, ED.

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

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