ERNURSE4MS

don't get me wrong, i love er, but not one episode goes by without me shouting at the screen. and the docs doing nursing stuff. that has me rolling on the floor. i have never seen a doc give an injection of anything more that local anesthetic, and chest compression, forget about it. in a code in my er the doc may intubate if a paramedic is not there other wise all he does is stand at the head of the bed and give orders. stay over to sit with a dying patient,never.

i totally agree. we have been called to the carpet for waits of 4 hours!! can you imagine that. the pt, family and administration seem to think that we keep them down in the er for spite or to cause trouble. we don't!! most of the time i have no control over how long a patient stays in the er. it is easier for me to get them out of there than to continue to be confronted every 15 minutes with "how much longer are we going to have to wait?" and "i want to go to a room right now!!" but back to the op i think our longest wait has to be 12 hours. got wrote up for that one!

EEEKKK! That is a bad siuation. My advice to you is to research emergency treatment for OB's in your TNCC courses. Also I would recommend NALS as well as PALS these have some really good neonate info in them. Also do you have round the clock ER docs? Most ER doc have experience with OB (I said most NOT all). Anyway, as with any other trauma's you have to treat the symptoms as well as get to the bottom of the cause. Remember, as an ER nurse, you treat MOM first then try to work on baby. If mom goes bad so does baby. I know the OB nurses have differing views on this but in the ER we usually don't have tocometers or continuos FHT monitoring. If you are like us you have a little hand held doppler and that is it. You have very little ability to really monitor baby. Your best bet is to stabilize and ship. Like what happened to me, even with OB/GYN on the premises you can still get bad OBs in the ER you still stabilize and ship( TO L&D) Good luck!

WOW. Talk about overkill. Unless there was something not in your post, what they did sounds alot like persecution. The scenerio does not add up. Has this happened to other nurses that you know of( in that faciliy)? Have you any other actions against you( for other problems)? If not, sounds like they have jumped the gun and I would make sure I talked to my union rep ASAP if I were you. In any case, I pray that this all blows over for you. And like the other posters have said. I would put in my 2weeks as soon as you get out of your hearing!

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.

Thanks for the replies. I have an update. The L&D nurse manager called me today and told me that I did a good job with that pt. She said I did exactly what I was supposed to do in that situation. She also said she took care of the comments about the amount of time the pt was in the ER. I feel better about the situation today, don't want to got through anything like that again though. She said the mom was doing okaytoday and that the baby was probably gone long before they arrived in the ER. Still sad for the mom.

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.

Thanks for the posts. This was stressful for everyone involved. I have never see an abruptio before today, but had studied the s/sx in TNCC several times. There were several factors that were difficult here. One thing I haven't mentioned was that this was a larger woman. She was about 5'4" and about 250# so she did not LOOK pregnant. My thoughts on sight were-MI, CVA or some other MS traumas. I was not until my medic told me she was OB did an OB emergency come to mind. As soon as he said that my thoughts were to get her to L&D as fast as I could but I knew I had to stabilized her first. She LOOKED BAD. She had that look of someone who was going to crash FAST. I have been doing this long enough to trust my gut. The other thing was that when I assessed her abd, it didn't feel like the text describe. Beneath the layer of fat the uterus was rock hard ( not like a contraction-I know how those feel)and not at the station I expected. . It was 2-3 finger widths below belly button. I have always been taught you look for the entire abd to be ridgid not just the uterus.Things just didn't FEEL right. I found out later that this had started several hours earlier and the mom had delayed coming. Still my prayers are with her and her loss. I am thankful that SHE survived though.

Thanks for the input. I do know the signs of OB emergencies. I felt that the mom was in too much distress to transport her without stabiliztion. BTW I checked FHT immediately and could not find any ( probable fetal demise prior to arriving to the er). The thing that got me, though is that the L&D nurses KNEW she was coming and didn't call and let ER know. I was taught that if we don't stabilize the mom then the baby has NO chance at survival. She was only in the ER 13 min from door to door.

Thanks SIRI. I don't have alot of OB experience( little to none lol). I can't think of anything I would have done differently. I understand how stressful it mest be for an L&D nurse to go through this senerio in their side but I don't want them to be blaming me for the fetal demise. Mostly I feel so bad for the mom. I WISH that there could have been SOMETHING I could have done to save her baby, but I know that there was nothing else I could have done without breaking policy at this hosp. I am glad to hear from someone with more experience on this subject like you. Again THANKS!

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 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 would like your opinions on this. Let me give you a little set up- I work in a rural level 4 ER (small 9 bed). In our hosp we triage all OBs before they go to L&D unless they are a scheduled induction or section. If they are greater than 20 weeks with + ROM, vag bleeding, contractions or HTN we MUST call L&D and give report to a nurse and get an OK before bringing the pt to L&D. Today we got a call from the clerk for a w/c in the parking lot. One of the medics(in hosp EMS) and our ER tech went to get the pt. They came back in with a VERY pale BF, extremely diaphoretic and near syncopal( you know the look-eyes rolling back and head lolling). The medic looked at me and said we need to get this pt in a room NOW( I had already came to that conclusion). I pointed at a trauma room and he shook his head and said OB. I get her in the room( a gyn room) and notice this woman has lost ALOT of blood lady partslly and had clear fluid mixed in. During assessment I find out she is 7month OB. About 2 min in the room she is vomiting profusely. We get her on the bed she is tachy at 119, BP is 140/100 and sat 100%. While we are getting her in the bed I have sent for the ER doc. He checks her and she is not dilated, but she begins to moan and stated she is having sharp pelvic pain.( She is G2 P1.) no fht.get a line and have had her in the room 5 min when the OB doc gets there and asks WHY is she still in the ER. I told him that she Just got here 5 min ago and I felt that she was not stable enough for me to transport to L&D without attempting to stablize first. We got a line and called L&D gave report and transported her to L&D. She was in our er for a total of 13 min. The house super called me 30 min later to tell me the pt had to have emergency section for total abruptio and the baby did not make it. She asked how long the pt was in the ER( she was not trying to place blame just curious. I had called to ask about pt). I told her and seems the L&D had made some comments about me not bringing the pt to them immediately. I found out that they KNEW she was coming and had not seen fit to let anyone in the ER know. I feel I did what was right. I have been taught to stabilize mom first then worry about the baby. That was what I did. The ER doc agreed with me and I know he will back me up as well as my documentation. I just wanted some opinions on what you would have done. Thanks- BTW I absolutely HATE doing OB. I feel totally overwhelmed by having more than one pt in a body.

wow i am a woman an just reading that mad me double over in agony. can you imagine? :uhoh21:

okay it does sound like the er doc missed the mark, but i have to stand up for the er nurse. i have been in this situation, where it was obvious the pt was having an mi but the er doc refused to believe this and even after being shown an elevated trop and ekg changes still didn't call it mi. i reported this in writing to nm, but felt like a fool calling report and having the nurse on the other end give me the 3rd degree. i cannot treat a pt without orders from a doctor. if the doc won't listen all we can do is cover ourselves. i thank the lord that my incident report was the final straw for this doc and he got the boot from our facility. i don't know the circumstances with the er nurse you dealt with but just wanted you to get a look from the other side.it is always sad when we know a pt is not getting the best care even though we tried.

i just wanted to put in my 2cents worth. i agree with dixielee. also i have noticed that the older generations( over 60) are more stoic. the younger generations have been raised ( for the most part) to think that they are entitled to never feel pain. they are more prone to whine and complain( we call 'em bmw-b**ch,moan,whine) about the least hurt and expect immediate relief for said pain. the older generation has been around when you didn't take something just because you hurt a little and aspirin was a major drug. they(usually) are more appreciative of any help. now that said there are exceptions to every rule and i do have my younger people who never ask for pain meds even if they are in agony and i just buried one of my oldest drug seekers( he was 80 and had killed his kidneys and liver with narcotics and booze).