Scary patient today..she was heading south quickly! I have seen labs go bad fast, but not sure if I have seen them go this fast! :uhoh21: At 6am Sat am, her platelets were 140,000 AST 45. midnight Sat, AST 145. plts 245,000. 5am Sunday, AST 2580, and plts manual count of 15,000 :uhoh21: yikes. Needless to say, she was under general anesthesia shortly thereafter for a section, (29.2 wks gestation). Her pressures 160s /100s even on MAg. And believe it or not, she was really asymptomatic, no headache, not even epigastric pain. And the scariest thing is, when we called our blood bank to get some platelets sent up to transfuse..they didnt have any and tried to tell me it would be 5 hours until they could get them. WHAT?!? Have you heard of such a thing? The anesthesia doc was waiting until we could at least get SOME platelets in her before we cut..but we certainly couldnt wait 5 hours!!! They ended up calling another hospital and shopping, and they sent some over. :balloons: She did well, so did the baby, and at 2 pm today her AST was 1280 WOOHOO!~!!
Specializes in Med-surg; OB/Well baby; pulmonology; RTS.
I have another question. We get a lot of babies from pre-eclamptic moms, as I stated before. The moms are usually on mag for 24 hours post delivery, and during this time they cannot come up to the NICU and visit. Is this because they need continuous monitoring or because they cannot sit up in a wheelchair? We've only had one or two come up in emergency situations and they're brought up on a gurnee. I'm just wondering about it because I don't remember learning too much about mag when I was in my OB rotation.
Gompers, when my DD was born last year at 32 weeks due to severe preeclampsia/HELLP Syndrome, I was on mag for the 24 hours post-delivery and I was allowed to go see my DD once the day after her birth, while I was still on mag, because I insisted. They didn't want me up OOB hardly at all because my reflexes were still very hyper and they were scared I would start seizing. My nurse wheeled me down to the NICU and I got to stay for 5-10 minutes which I was still pretty groggy from the mag and my PCA (repeat c-section) and then I was taken back to my room and put back to bed until the mag was d/c'd later that night.
Specializes in postpartum, nursery, high risk L&D.
Speaking of HELLP patients that go south quickly...today I had a mom who had come in a few days ago at 29+ weeks with some transient abdominal pain, but otherwise asymptomatic for PIH, pressures WNL, labs fine. they did gallbladder u/s which was fine, baby looked great, and so she was discharged home after a day or so. Yesterday she presented to the ER with severe RUQ pain, again asymptomatic otherwise and labs initially WNL. At noon her platelets were 126,000; I'm not sure why the physician ordered repeat labs so soon but at 1400 they were in the 90,000's and liver enzymes starting to climb and an urgent section was called; by 1700 platelets were around 40,000 and liver enzymes through the roof. that just doesn't seem like it should be physically possible!
Burnt Out, ASN, RN
647 Posts
Gompers, when my DD was born last year at 32 weeks due to severe preeclampsia/HELLP Syndrome, I was on mag for the 24 hours post-delivery and I was allowed to go see my DD once the day after her birth, while I was still on mag, because I insisted. They didn't want me up OOB hardly at all because my reflexes were still very hyper and they were scared I would start seizing. My nurse wheeled me down to the NICU and I got to stay for 5-10 minutes which I was still pretty groggy from the mag and my PCA (repeat c-section) and then I was taken back to my room and put back to bed until the mag was d/c'd later that night.