Med/Surg nurses, opinions please on this scenario

[FireStarterRN, BSN, RN]

Here's the scenario: A patient is being transfered by ambulance from a smaller facility for appendicitis. Reason for transfer given is no on call surgeon at small facility. Pt is a 20 something young woman. Pt arrives at around midnight, you call the accepting surgeon who gives you minimal orders for IVF, pain and nausea meds, and when asked he informs you that he will do the surgery at 8AM. He has not seen the patient at this point, nor viewed the radiology CD from the small hospital.

You go and inform the patient and her mother. Both are upset, why did they just ride 30 minutes in ambulance for nothing, what if appendix ruptures, they ought to go home and wait, this is ridiculous. Pt wants cigarette, had pain meds previously and is comfortable, getting drowsy. Mom is rather irate, says that ER nurse from other facility said her daughter would be going straight to surgery.

I thought she had a very good point and called back surgeon and presented her point and he also saw her point, ended up coming in and doing the surgery right away. I was just staying to help with the admit but heard the outcome was good.

It just so happens that I used to work at the smaller hospital and as I recall appys were done right away there. When I worked Med/Surg there I never remember sitting on an appendicitis case all night like this surgeon wanted to do.

The surgeon is over from the other side of the mountains filling in ad locum for a month for a buddy of his (he used to work here) He says that where he's working now they routinely wait till morning for these types of cases.

Any input?

[PostOpPrincess, BSN, RN]

Some surgeons will sit and wait a few hours if they are the only one on call in the ER and they've had back to back cases and NO REST--emphasis on NO REST and there is no other back up surgeon. This is a very, very infrequent occurrence but it has happened.

For safety reasons, I think I would want an accurate surgery done before a haphazard one.

[FireStarterRN, BSN, RN]

I was always under the impression that appys were best attended to immediately in order of avoid a rupture.

[keithjones]

i was admitted to a small town hospital for appendicitis had high white cell count and all had ivf and pain meds drank a ton of water overnight and was fine by noon the next day... is that odd?

[wooh, BSN, RN]

I've seen them sat on. I've seen them done immediately. I've seen them rupture. I've seen them rupture when I knew on admission it was obviously a hot appy and watched them twiddle their thumbs for three days doing countless tests arguing over whether or not it was actually appendicitis. I can never 100% predict what they're going to do. And I've flat out quit trying.

I personally for myself would rather risk rupture than a sleepy surgeon. I'd also prefer it if other facilities' staff didn't tell patients/families what will happen when they get to our facility. Because 9 out of 10 times they're wrong. And I spend a ton of time explaining why this or that won't happen. Of course, I'd also prefer it if our own ER staff didn't tell patients/families what will happen when they get to the floor. Because 8 out of 10 times they're wrong. And I spend a ton of time explaining why this or that won't happen.

[BrnEyedGirl, BSN, MSN, RN, APRN]

I work in a large truama center, but we frequently hold hot appys. Unless the CT shows a very enlarged or abcessed appy they usually wait on IV fluids, pain meds and abx.

[NurseCard, ADN]

Hmmmm.... I have seen MD's wait until AM to operate on an appendix. I guess it just depends on how bad the appendix looked on film, or whatever. If I KNEW that the accepting surgeon hadn't even looked at the scans, I would be rather uncomfortable, yes. Unless of course they had conversed with an ER doc who had looked at the scans and advised them that the surgery could wait until the AM.

But anyway, yes I've seen patients be admitted in the middle of the night for pain meds, IVF, and surgery to occur a few hours later.

[NurseCard, ADN]

I was always under the impression that appys were best attended to immediately in order of avoid a rupture.

Again, it probably just depends on how "hot" the appendix looks on film. Like someone said, in a case like that the risk of a sleepy surgeon doing the surgery far outweighs the risk of the appendix rupturing.

Also, while an appendix rupturing isn't exactly a great thing, it's not the life threat that it once was.

[chicookie, BSN, RN]

How funny, last week someone came in and was here for two days before they were operated on.

So to answer your question. Yes. Yes I have seen it.

(I really don't like that surgeon. He is such a know it all.)

[Roy Fokker, BSN, RN]

I was always under the impression that appys were best attended to immediately in order of avoid a rupture.

Nope.

Sat on a lot of appys (even sent a couple home) :)

cheers,

[Elvish, BSN, DNP, RN, NP]

The floor I work on gets overflow medsurg patients if they're female....and I've seen quite a few appy holds.

[FireStarterRN, BSN, RN]

So, it sounds like the problem here was that the other facility was unwilling to hold the patient until morning and their ER nurse informed the patient and her mother that she would be going to surgery immediately.

The mother was particularly upset that her daughter was going to be stuck with a $5000 ambulance bill (she said). Her daughter didn't have insurance. They had all ridden the 30 mile drive in an ambulance.

Anyways, the surgeon I think wisely came in and did the surgery basically in order to avoid a PR problem with Mom, after I described her concerns. Squeaky wheel gets the grease. I don't blame Mom for being upset, given the circumstances and what she was told.