GYN patients in ER (I fought last night with GYN resident!)

[NYCRN16]

Last night I was working, and at 11 pm I overtook another nurses assignment, so I didnt see her patients at all before I took over. This is the scenerio:

This one patient was 8 weeks pregnant, presented with slight vag bleeding, and it was discovered that the fetus had no heart beat. GYN came down and saw the patient, and was giving ED attending a hard time about admitting her. About 5 minutes after the nurse endorsed to me her patients (no report given to me either, so I didnt know the entire story), the patient's husband comes yelling, screaming and threatening me because his wife "didnt get her medication and its been hours, ect". I tried to explain to him that I had just taken over for the other nurse, and I was trying to figure out what was going on and what she needed. Needless to say I had him thrown out by security, but not after getting yelled at and followed around everywhere by him :angryfire. When the resident then came to me and started in with me as well, no wonder the husband was pissed, the resident got him all riled up and was like "the nurse didnt give her her meds". What did he want given? He wanted a pitocin drip started there. I told him no way in hell. If he wanted a pitocin drip, then he can admit her to L+D and give it up there, because there is no way I can safely monitor her with 9 other patients while she sits there in the hallway. If he needed some pitocin, then we can give it to her IM until she gets up there. He says "well arent you a nurse? you dont know how to give pitocin?" :angryfire :angryfire

I was like "Oh yeah? Next time I am out of tele, ICU or CCU beds, I will send my patient to L+D and let them manage a nitro/heparin/labatolol/dopamine/nitroprusside/whatever drip while having 4 laboring women, and lets see how they manage" :angryfire :angryfire

The woman wound up getting IM pitocin, with no ill effects, and after many angry phone calls by my ED attending to the OB attending, she was admitted.

I dont know about anyone else, but I do not feel comfortable hanging this type of drip on a patient who is sitting in the hallway, who I KNOW I cant monitor every 5 minutes or whatever. Maybe I am alone in this, but its my license (and this woman's uterus). I did explain to the patient after this jackass left, what he had prescribed, why I was not going to give it to her here, a and that she would get some of the same medication, but in a safer way while sitting in the ER. I told her (and her mother who was sitting there) that I really dont care what the doctor says, if I dont feel its safe for the patient, I wont do it. The mother then said that she worked in OR for 25 years (I dont know if she was a nurse or a tech or what), but she said that she agreed.

I cant imagine being responsible for rupturing someones uterus and all the things that go along with that. :stone

Thanks for listening to my rant! :) b

[canoehead, BSN, RN]

You did well. Even IF you had less than 9 patients, did he expect to deliver her in the hall? This was a doc problem and he tried to pass it off on you (nice try buddy).

[ERNurse752, RN]

She was only 8 weeks, having slight bleeding, and they wanted to give Pit? I've never seen that before. Is that common?

Where I work, for early pg with slight bleeding, we don't usually do anything in the ER but have them follow up with OB. For heavy bleeding, they just usually go for a d&c, or sometimes Methergine is given.

[SmilingBluEyes]

Seems to me a D an d C and methergine were in order, as an OB nurse and person who has had 4 pregnancy losses, I have never, ever heard of pitocin drips for 1st trimester miscarriages. Weird..... Anyhow, I am sorry you had such a bad time. Bless your heart, you did the best you could.

[BittyBabyGrower, MSN, RN]

I'm with you on the pit...I've had two miscarriages at 8 and 12 weeks and no pit here...they let nature take it's course and if the levels are still up there you get a d/c, at least that is how it is where I work. That resident sounds like a really butt.

[rnmi2004]

ITA, I have never heard of a pit drip for an early miscarriage. I've never even heard of an IM pit for that early. My sister had 2 miscarriages & they didn't give her any drugs, just waited to see if her body would take care of the situation. She had bad cramping anyhow--I can't imagine if they had added pit on top of everything else.

The resident needs some education on how to handle this type of situation in the future.

[NYCRN16]

Seems to me a D an d C and methergine were in order, as an OB nurse and person who has had 4 pregnancy losses, I have never, ever heard of pitocin drips for 1st trimester miscarriages. Weird..... Anyhow, I am sorry you had such a bad time. Bless your heart, you did the best you could.

You are right about the Methergine..that is what I gave (I assumed it was some sort of brand name for pitocin?). Glad to hear from you, and experienced OB nurse that the pitocin drip was out of order.

[z's playa]

Awesome job of pt advocate. I had 3 miscarriages and was brought to OR for all but one when they sent me home with misoprostil(cytotec) oral. Talk about painful.

[SmilingBluEyes]

How are you doing today? I hope better.

[traumaRUs, MSN, APRN]

We do give Methergine IM in our ER - however I've never seen it for an 8 week pregnancy. BTW - heartbeats (at least by our dopplers) aren't able to be heard until 10-12 weeks. Just curious. You did a great job advocating for your patient - congrats.

[obliviousRN]

We've just let nature take it's course that early unless they are hemorrhaging. There's really no call for IM methergine in the case you described. Medication that is not needed is poor pt care for that MD. Good for you for standing up for your pt!