OB Emergencies

Specialties Ob/Gyn

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Okay, this is kind of long but I wanted some input on this. Let me give you some back ground. I work in a rural ER( level 4 and 9 beds). We triage all OB's that come in except scheduled inductions or scheduled sections. We call L&d if they are greater than 20 weeks with + ROM, vag bleeding, contractions, or HTN. We MUST give report to the L&D nurses and get an OK BEFORE we bring them to L&D. This afternoon we got a call from the ER clerk for a w/c in the parking lot. One of the medics and the ER tech went out with a w/c. The came back in with a VERY pale BF, extremely diaphoretic and near syncopal( eyes rolled back and head lolling). He said he needed a room NOW. I pointed at the trauma room and he said no OB :eek: We get her into the gyn room and I noticed that she had lost ALOT of blood lady partslly and there was clear fluid mixed in. While getting her into a gown and assessing her she begins to vomit and complain of sharp pelvic pain. I find out that she is G2P1 7month OB. While we are getting her in the bed I send for the ER doc. He checks her pelvicly while I get VS. She is not dilated but the blood IS lady partsl. VS tachy at 119. BP 140/100 sat 100%. We get a line and the OB shows up and asks WHy she is still in the ER. I told him she had just got there 5min ago and that I felt she was not stable enough for me to transport before getting vs and stablizing. He wants her in L&D so I call report and get her to L&D. She was in ER 13 min. I called the House super to get and update and she said she would callme. 30 min later she called and asked how long the pt was in the ER and I told her. She told me that the pt had gone for and emergency section. She had total abrutio and the baby had not made it. Apparently some of the staff in L&D had made some negative comments about me not bringing the pt immediately back to L&D. I was taught that we stabilize first and we treat mom first. I feel like I did what I could and was supposed to do but I would like your opinions about what you would have done. Thanks. BTW I am NOT an OB nurse I REALLY don't like OB very much at all. I like one pt in one body. I have all the respect for all the ob nurses. more power to ya.

Okay, this is kind of long but I wanted some input on this. Let me give you some back ground. I work in a rural ER( level 4 and 9 beds). We triage all OB's that come in except scheduled inductions or scheduled sections. We call L&d if they are greater than 20 weeks with + ROM, vag bleeding, contractions, or HTN. We MUST give report to the L&D nurses and get an OK BEFORE we bring them to L&D. This afternoon we got a call from the ER clerk for a w/c in the parking lot. One of the medics and the ER tech went out with a w/c. The came back in with a VERY pale BF, extremely diaphoretic and near syncopal( eyes rolled back and head lolling). He said he needed a room NOW. I pointed at the trauma room and he said no OB :eek: We get her into the gyn room and I noticed that she had lost ALOT of blood lady partslly and there was clear fluid mixed in. While getting her into a gown and assessing her she begins to vomit and complain of sharp pelvic pain. I find out that she is G2P1 7month OB. While we are getting her in the bed I send for the ER doc. He checks her pelvicly while I get VS. She is not dilated but the blood IS lady partsl. VS tachy at 119. BP 140/100 sat 100%. We get a line and the OB shows up and asks WHy she is still in the ER. I told him she had just got there 5min ago and that I felt she was not stable enough for me to transport before getting vs and stablizing. He wants her in L&D so I call report and get her to L&D. She was in ER 13 min. I called the House super to get and update and she said she would callme. 30 min later she called and asked how long the pt was in the ER and I told her. She told me that the pt had gone for and emergency section. She had total abrutio and the baby had not made it. Apparently some of the staff in L&D had made some negative comments about me not bringing the pt immediately back to L&D. I was taught that we stabilize first and we treat mom first. I feel like I did what I could and was supposed to do but I would like your opinions about what you would have done. Thanks. BTW I am NOT an OB nurse I REALLY don't like OB very much at all. I like one pt in one body. I have all the respect for all the ob nurses. more power to ya.

This might be a good time for a policy change. I work in a small community hospital and EVERY OB (over 20 weeks) is brought directly to OB and we do the triage. You did nothing wrong (and everything right) but personally, I think it is time for your ER to stop douing any triage on pregnant ladies. It will be one more liability off your hands.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

WOW I don't think this was the STANDARD triage scenario. I am not sure anyone could have done anything differently. If the lady was shocky in the PARKING LOT for heaven's sake, what could have bringing her into OB have done for her to improve the outcome????

If anything, like I said, OB could and should have responded IN THE ED and helped stabilize and prepare for STAT section.

It could be, their policies are fine----but every policy has gray areas, like this one, not easily covered. I think the OP did fine, given the trainwreck of a case she was faced with.

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Oooooh, what a harsh judgment!!! :nono:

You are right, it was a harsh judgment. The man who my soul mate is 50 lbs overweight. He says he doesn't take care of himself the way he should, and neither do most of us in some area or another. Her measurements are an indicator of problems. Sorry if I offended anyone.

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Thanks for all the replies. I have an update. The nurse manager for L&D called me today. She said I did a good job with the pt. She said I did exactly what I was supposed to do and probably saved the mom's life. I appreciated the kudos from her even though they were not necessary. She said she took care of the comments about the pt needing to have gone straight back. I did make me feel a little better to find out that the baby was probably gone before she ever got to the ER. This was just one of those live and learn incidences that go on everyday for nurses everywhere. It was definitely a hairy situation that I hope not to repeat. Again I have to say KUDOS for all those L&D nurses out there that deal with this kind of thing daily. I will stick with my ER though lol.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

well gee, the L/D manager and I agree.

GOOD for you! KUDOS!

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Specializes in Case Mgmt; Mat/Child, Critical Care.
Thanks for all the replies. I have an update. The nurse manager for L&D called me today. She said I did a good job with the pt. She said I did exactly what I was supposed to do and probably saved the mom's life. I appreciated the kudos from her even though they were not necessary. She said she took care of the comments about the pt needing to have gone straight back. I did make me feel a little better to find out that the baby was probably gone before she ever got to the ER. This was just one of those live and learn incidences that go on everyday for nurses everywhere. It was definitely a hairy situation that I hope not to repeat. Again I have to say KUDOS for all those L&D nurses out there that deal with this kind of thing daily. I will stick with my ER though lol.

Glad you got this input, hope it made you feel better. You did absolutely fine, btw, during the situation. You should pat yourself on the back, you helped save this mom's life. Sorry for the babe, of course, nothing you could've done there. Treat yourself kindly, being on the "front lines"....you need to do that! :kiss

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Thanks for all the replies. I have an update. The nurse manager for L&D called me today. She said I did a good job with the pt. She said I did exactly what I was supposed to do and probably saved the mom's life. I appreciated the kudos from her even though they were not necessary. She said she took care of the comments about the pt needing to have gone straight back. I did make me feel a little better to find out that the baby was probably gone before she ever got to the ER. This was just one of those live and learn incidences that go on everyday for nurses everywhere. It was definitely a hairy situation that I hope not to repeat. Again I have to say KUDOS for all those L&D nurses out there that deal with this kind of thing daily. I will stick with my ER though lol.

I am an OB nurse who BRIEFLY workd ED and went back to OB. I am impressed that you got the pt out the door in 13 minutes!! You did awesome!! Even if she came directly to the floor it would not have been faster.

People are always really quick to judge when they are not the ones involved. I'd like to see those nurses who were so critical of you deal with a non obstetrical emergency.

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Glad you got this input, hope it made you feel better. You did absolutely fine, btw, during the situation. You should pat yourself on the back, you helped save this mom's life. Sorry for the babe, of course, nothing you could've done there. Treat yourself kindly, being on the "front lines"....you need to do that! :kiss

You did an excellent job by far! I hope you realize that! An ER nurse does not immediately think OB when a female comes in; an OB nurse does not think epileptic seizure when a pregnant woman arrives... although it happens and eclampsia is not the only reason why someone would seize...

The death of a baby is a JCAHO sentinel event, and I do hope your departments set up some new guidelines so that events like this run smoother. Communication is critical. If L&D knows a pt is coming, they should notify you. Likewise, you should stay in contact with them.

Our labor nurses attend all OB traumas in the ER because of situations similar to this. We accompany the pt to XRAY, CT, etc. and document FHR. If the pt is admitted to an ICU a labor nurse is available 24/7. We are wherever the mom is until she delivers. But it took many bad outcomes before we put together guidelines that work. Its about the patient and who can provide the best care, not only where that care takes place.

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Midwife- what I hope happens from this is that the lines of communication between L&D are opened. There seems to be a big lack of communication in general but most of all with L&D. I don't understand it. There are weekly incidences of L&D knowing a pt is coming in for whatever reason and until we call to give report, or (if they don't meet the policy) have seen and treated, THEN the L&D nurses telling us"that pt was to come straight back" How am I to know? I'm not psychic. Time for a change in policy. To what end I don't know.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

That is something to be taken to managers to work out then. Document each and every truly difficult incident w/ob in an occurence report, if need be. Changes only happen when/if these things are documented and taken up the appropriate channels. But things can change if you are keeping clear, articulate documentation of the problems, to begin with.

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Specializes in L&D.

It's sad that in our society, whenever there's a bad outcome people look to blame someone for it. What needs to be done if for people to sit down together and discuss what happened and why. How did the system break down? What can be done to fix the system?

When L&D knows a bleeder is coming in and it's your standard procedure to triage all OB patients, they should call and warn you to bring this one right away. As soon as you find out a shockey, bleeding woman is OB, you call L&D and give them a heads up so they can set up the OR and/or send an L&D nurse. Since the L&D manager called you, it sounds like she has looked at things and is thinking along those lines already. Has she spoken with the ER manager? It's time we started looking at situations like this as opportunities to improve our care not as opportunities for blame.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I agree. But if this is an ongoing problem, like it seems to be, it's time to move it up the chain and let managers become involved, too.

Maybe policy changes are in order.

Certainly attitude changes are.

If managers are not aware, they need to be---if they are and still are not acting, maybe it's time for an inservice for staff.

Like Nora so wisely said, what you have here is an EXCELLENT opportunity to "dissect" the situation and learn from what was done right; also learn from what could have been done better . This is no time for anyone (particularly L/D) to get all into "Monday morning quarterbacking" here and criticizing your every move. It's time to LEARN from it.

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