Ok, so we have this pt yesterday who has spent at least a month on Antepartum High Risk with elevated liver enzymes. She is really, really sick. They did a PIH workup on her, and determined she was not preeclamptic. They did a liver biopsy and all of her Hepatitis tests came back neg - for some reason, she has a fatty liver, but no one can figure out why. She is 17 years old, 34 weeks, I think. Started contracting yesterday on AP and baby was having rare decel's, so they scheduled a C/S for 1400. We get her over to us at about 1:45, put her on the monitor, and her nurse is helping her breathe with her contractions and she is doing great, though complaining of severe pain. Baby is running 130-140's. Suddenly, I think about 4 of us are at the desk and see her strip plummet into the 40's and not come back up. So we all go tearing in there to help her nurse, flip her back and forth, put on 02, turn up her fluids - the usual stuff - and she's still not coming back up. She is screaming at the top of her lungs and fighting us; we're trying to check her cervix, put in a foley, shave her, and get the bed out the door to the OR, still waiting on the word from the doc. We get it, and she is shreiking down the hall on the way to the OR about her stomach; we get FHT's in the OR and it's still in the 40's. They put her under, get the baby out in about 4 min, and it is gray, floppy, no resp effort, and no heart beat. In our hospital, we have a High Risk team consiting of a RT, ICN nurse, NNP; they get the baby and start NRP. Apgars 0 and 4, 3 min without a spontaneous heart beat. This was the first time I had ever seen a megacode like that. I was watching over the RT's shoulder and he put me to work bagging the baby! I thought I would not be able to handle that situation well when the time came, but I did, and I was fine. I don't know how long it was (you know it always seems like nine years passes and it's only a few minutes), but the heart started beating on its own eventually and they took it to the unit on a vent. Here is the crazy thing: there was thick mec in the fluid (poor baby was completely stained green) and the doc said that SHE DID NOT ABRUPT!!!!!!!! The cord gas came back like 7.18. We were all completely kerflummuxed - what on earth could have caused this??????? Was this baby just majorly stressed and not able to take the contractions anynmore? If she has some kind of virus, would that have done it?
The good thing is, I am starting to feel like I can do this whole nursing thing! I feel more and more confident everyday, and am really getting some hard pts now (severe shoulder dystocia, pp hemorrhage, twins). I love my job!
