Lowest H/H I ever saw...

LindaMarie76 · Apr 19, 2005

We have protocol that states if a H/H is below a certain value, the patient must be admitted to ICU (or ER holding).

Same goes for K and Na values

Linda

My pt was a leukemic pt, in his 80's full code with a sbp 90, hr 90s, pale as a ghost c/o cp on tele unit. The pt was admitted 1 hour before my shift, it was going to be a long 12 hrs!
The PMD had a consult for hematolohy, GI and oncology. I called them all but they did not know the pt. I did not have time to wait for compatible blood, so someone had to sign the permission for tranfusing incompatible blood. None of the specialist want to come in (of course, it was not their job, even if the PMD was insisting that I called them to sign it).
The PMD never got to see the pt in the ER because it's supper time and the day is over for them. His Hgb was 4.9 at 6 pm, I drew another one and he was 3.5-14. I had to transfuse him. He was also c/o CP (obviously symptomatic) while his neighbour that I was titrating dopa wanted the bedpan, tissues and a glass of crandberry juice!
Chaos! While I am dealing with this poor man who is now diaphoretic, I am giving IV fluid wide open, nobody want to give the order for that either (Gosh, he may get to CHF!) :angryfire
Now try to transfer this dead guy in the ICU, to hear the sup say: I hope this is worthwhile! It's finally, 10 PM when I got the pt in ICU, that the PMD came in to sign the blood transfusion paper! Hikes!
I still had to see my other 6 pts, and pick 3 more for 11 PM. What a nite! I now work in the ICU! :balloons:

Nurse Hatchett · Apr 19, 2005

My dgtr's (was 8 mo old at the time) hgb was 4, can't remember the hct. I was kind of in a daze. They thought she had leukemia at the time, rushed to Riley Children's hospital, blood transfusion gave and found out she had TEC. I can't remember the whole name, just abbreviations. It was very scary, she also had sleep apnea, so the whole way down there, we had her hooked up to her apnea monitor to monitor resp. also!

wendyp72 · May 19, 2005

...was on a post gastric bypass reversal. Worked with her all night, vitals stable as a rock. Feelin' fine, SaO2 99% on room air, SR 78, BP 120's, tummy soft, minimal pain, minimal serosang drainage from RLQ Blake. A.M. H/H 5/15, repeated. Anyone else?

The lowest I have ever seen was 4/10...The lady was in her early 80s...bleeding after a frickin' lap chole! Looked like a wax replica of a person...no color at all!! I have never hung so much platelets, FFP & PRBCs....The surgeon was VERY nervous!!

naggytabby, BSN, RN · May 19, 2005

female, adult, HIV + who WALKED into clinic stating she felt 'really tired'- was on AZT- H&H of 3/6. sent her to the ER for a transfusion (and switched the AZT portion of her therapy!). she did great.

mommatrauma, RN · May 19, 2005

Had a patient the other night go from a crit of 37 to 22 in 3 hours--not sure what the hgb was. Upper GI bleed. between vomiting and the NG tube, we got 1400 cc of blood out of her stomach before sending her to the unit. Last BP on the floor was 48/??. One of the other nurses saw her being RAN into the OR an hour after we sent her to the unit.

HGB is usually about 1/3 of the crit...so you can guestimate that it was probably about a 12 to a 7 drop....That is a lot in 3 hours...

begalli · Jun 5, 2005

Had an admit from the floor to ICU at shift change this am. Whew! This patient KICKED MY BUTT!

When they found him in respiratory failure (actually near dead) with a systolic of 56 at 7:15 am! (did no RN look at this guy all night - docs found him on their rounds!), they began resuscitation while preparing to transfer to us. Hct at 07:20 was 24.8. When I sent labs at 08:00 his hct was 16.4/hgb 5.2! That's more than an 8 point drop in less than an hour. I suppose that some of that was dilutional, but when I sunk an NG he put out a 1200 mls of coffee grounds in about 10 minutes (later, I suctioned this same coffee grounds from his lungs too :angryfire ). His sugar was 34; abg: ph 6.18; Co2 120; po2 62; bicarb 4.2! Talk about lowest values!

Liver ca, end stage. Poor fellow. No one could get a hold of his family, he was a full code (no compressions were done) who was coherent and awake the evening before. This guy's belly doubled in size right before my eyes. They were doing everything - intubated, lined, pressors, ffp, blood, fluids, bicarb, after bicarb, after bicarb, after bicarb and D50. He was coagulopathic too and COLD! We couldn't get a temp.

I worked over for 4 hours to admit this guy this morning. I can't believe I drove home - I was absolutely exhausted, but the docs were such a pleasure to work with - they knew I was pulling 16 hours. When the Attending arrived at about 9ish, he had his chat with his Residents and Fellow as I listened, busily rushing around doing crap and then he turned to me and asked if I had anything to add or any ideas, or do I need anything, and not to worry about the swan and continuous cardiac output set-up until I'm ready. I just can't explain that feeling of validation and respect when you feel that you're about to fall flat on your face.

Patients like this really break my heart. He was relatively young too. The thing that REALLY bothers me is that this patient was transfered to us from a monitired unit. So sad.

Wait. What was the topic of this thread? :chuckle

Good to get all of that out.

pickledpepperRN · Jun 9, 2005

[quote name=

I know I still get cross-eyed though when I read "2L NS wide open"[/quote]

I often care for CHF/pulmonary edema so was SO nervous caring for a burn patient. They need SO MUCH fluid!

OK - back to topic -

Years ago we first met a young mother with sickle cell. Her H&H was about 4/12 when she was admitted for transfusions. In the morning I helped her to the bathroom (I was then working M/S). Whe she rang to go back to bed she looked healthy, no anemic. She did it with make up. I couldn't imagine how she had the strength. She worked full time almost until dying in her forties.

This lady was our patient from the time her son was four until she died in our CCU the summer after he graduated college.

allnurses Guide · Jul 3, 2005

angelique777 · Jul 3, 2005

Hct 2 Hmg 7...22y/o Jehovah witness...bleed out from scalp lac p rolling a Ford Explorer(other injuries easily manageable) Weeks on vent...epogen...iron...birth control pills. With lab draws qod, her blood literally looked like Hawaiian Punch. She walked back in months later and looked great.

What does the birth control pills do :confused: ............sorry only 6months experience as RN not sure how birth control pills help with the low H/H

Gompers, BSN, RN · Jul 3, 2005

What does the birth control pills do ............sorry only 6months experience as RN not sure how birth control pills help with the low H/H

The Pill makes you have regular cycles that tend to be much lighter than what your body would do naturally. Some women actually get anemic just from having a monthly period! I actually knew someone who took a Pill that had iron in the placebo pills to give her a little boost.

But in that particular story about the Jehovah's Witness woman, I'm guessing they kept her on the active Pills nonstop to prevent a period from even occurring, to limit any kind of blood loss.

LadyStorm · Jul 3, 2005

What does the birth control pills do ............sorry only 6months experience as RN not sure how birth control pills help with the low H/H

Birth Control Pills regulate menstrual periods and decrease blood loss during that time. I'm sure this pt was on them so that blood loss during her period did not add insult to injury.

angelique777 · Jul 3, 2005

Birth Control Pills regulate menstrual periods and decrease blood loss during that time. I'm sure this pt was on them so that blood loss during her period did not add insult to injury.

Totally had my mind on my own patient who is a JEHOVA WITNESS with similar problem except she is like in her 70's (no menses here lol) just totally was not thinking about the patient menstrual cycle .. :bugeyes: :doh: lol thanks

Angela