had a through and through gunshot tonight that went through left leg and then through the member
ER doctor said not to cath the pt, and then a little later the trauma surgeon who came in to see my pt said to cath him.
I tried and couldn't get it so told the trauma surgeon who said to call urology to come
my ER doctor went ballistic when he found out I had tried to cath the pt, said never listen to the trauma doc's and always ask the ER doc if it is okay first.
Fortunately in the long run the guys member is okay, I didn't damage the urethra after all.
I feel terrible. I know that you never cath a pelvic fracture etc, but I stupidly thought that it was okay if the trauma surgeon said to.
I am not a nurse who listens and obeys the doctors no matter what but I didn't second quess this order like I should have.
Thank God my pt is okay in spite of me.
I did report myself to the house super and the urologist. They were okay with what I did, but of course that doesn't make it right.
It is so scarey to think how easy it is to make a mistake, no matter how careful a nurse you are.
Specializes in vascular, med surg, home health , rehab,.
Long story-short
had a through and through gunshot tonight that went through left leg and then through the member
ER doctor said not to cath the pt, and then a little later the trauma surgeon who came in to see my pt said to cath him.
I tried and couldn't get it so told the trauma surgeon who said to call urology to come
my ER doctor went ballistic when he found out I had tried to cath the pt, said never listen to the trauma doc's and always ask the ER doc if it is okay first.
Fortunately in the long run the guys member is okay, I didn't damage the urethra after all.
I feel terrible. I know that you never cath a pelvic fracture etc, but I stupidly thought that it was okay if the trauma surgeon said to.
I am not a nurse who listens and obeys the doctors no matter what but I didn't second quess this order like I should have.
Thank God my pt is okay in spite of me.
I did report myself to the house super and the urologist. They were okay with what I did, but of course that doesn't make it right.
It is so scarey to think how easy it is to make a mistake, no matter how careful a nurse you are.
I am really spooked by what happened[/quote
Where is your error? Your ER Doc expects your to run back to him to check that every order a consult gives you is ok with him? Then why consult anyone at all? He obviously considers himself to be the Ultimate Authority.
Like you'd have time to do that. Imagine one shift where every nurse ran every consult order by him, he'd go insane. The trauma surgeon gave a reasonable order. You did your job. Why are you feeling so badly?
because I distincly remember (now) that one of my nursing books a long time ago said to never catheterize a bleeding member. It is scarey how much you have to know as a nurse. And I have always prided myself on knowing a lot. (for the safety of my patients)
Thanks to everyone for their input. I see that I am not the only one that would have followed the trauma surgeons order too.
I actually like and respect both of these doctors and they are relatively easy to work with.
I hope the ER doc doesn't think I'm not safe with my patients any more.
This whole incident will have to go in my "very importtant lesson" book and I know someone down the line will benefit from it.
The most important thing is that my patient is gonna be okay.
Specializes in CVICU, Burns, Trauma, BMT, Infection control.
The consulting doc that the ER doc called ordered something that the ER doc didn't like it wasn't your mistake. ER doc(Dr Ego) didn't communicate with trauma surgeon and visa versa and when you did something he didn't like took it out on you making you feel that you did something terrible,you didn't.
The only thing you might do in the future is be mindful of Dr Ego and show new orders to him from consulting docs so that he can address the issue then.You were caught in the middle. What some places never do are routine in other places. Your pt is fine.
because I distincly remember (now) that one of my nursing books a long time ago said to never catheterize a bleeding member.
A bleeding member and a pelvic fx are two different things.
The OP stated pelvic fracture, not bladder rupture or other abdominal/pelvic organ trauma.
I'm glad your patient is doing fine.
But this don't-catheterize-a-pelvic-fx is just not typical practice. Do you propose repeatedly positioning & repositioning that fractured pelvis on a bedpan?? I didn't think so.
some bleeding member (what's the plural) are bleeding because they pulled out a foley with the balloon inflated, in that case, you want to get the foley back in quickly before you can't get it back in and then you have to call the urologist to get it back in
In this case there was the worry that the bullet had transected the urethra and that the foley would further ruin it.
I can see from all the replies though that perhaps my ER doctor was a little over the top with worry. But he said he had seen this happen and the patient was left badly disabled.
Had a similar situation, a guy came in bit by a rattle snake (and his drunk buddies brought the snake in to the ER too, but that's another story). we had a locums in the ER, and the hospitalist came in too. they were fighting over solumedrol or anti-venin (yes that is the way it is spelled not anti-venom). The guy was in full anaphylaxis and me and the other nurse just told our US to call the CRNA to intubate and then call for a helicopter.
The docs were so busy trying to talk each other down (read yelling at each other) that they didn't even realize until the CRNA was there and we were trying to get him intubated.
They were kind of mad at us, but still fighting. The medical director did an investigation and told us both that we did an outstanding job and probably saved the guys life.
Mulan
2,228 Posts
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