Monday, March 29, 2010

This is what you don't want to think to yourself upon entering a room:

"Hm. Where's all that blood coming from?"

You especially don't want that to be your first thought when your patient is intubated and ventilated and Dipped and generally not terribly responsive.

Moreover, you don't want that to be your first thought, because your second thought will invariably be, "Gosh. I wonder if that blood is still coming, or if it's stopped."

Especially when the last time you saw the patient was about three minutes ago.

And the last thing you want to do in that situation--but the first thing you ought to do--is pull back the sheet. There's a moment, when you realize that yes, that is blood on the floor and around the foot of the bed, that your hand reaches out automatically to twitch the sheet off of the patient. There's a nearly-simultaneous moment during which you hesitate and your brain prepares itself for whatever the hell is under there. The drip-drip-drip of blood on the floor is not a sound any nurse ever wants to hear.

What was under there was just a picnic. The patient had had an angiography at a hospital in Nowheresville and had developed, as the patients from that hospital tend to do, an abscess at the angiography site. I don't know if they lick their catheters clean between cases, or what.

Anyway, I twitched back the sheet. I saw a pulsing mass of mixed blood and pus, a result of the abscess eating through the wall of the artery. And I, with gloves already on, dropped the washcloths I'd gone to get onto that mass and pressed the knuckles of my right fist hard into the now-squirting angio site. And yelled bloody murder.

Two of my nursing buddies came in hard on the heels of that yell, assessed the situation in a glance, and ran back out. One got a whole wad of towels and washcloths; the other called an overhead emergency page for surgery and then gave the OR folks the heads-up. A doctor and an intern followed and spelled me on the pressure-giving. An RT came in like the hounds of hell were on her heels and, without asking questions or making any statements, began to ready the patient for transfer to the OR.

From the time I walked in to the room to the time I ran out of the room, alongside the OR gurney, keeping my fist pressed hard into that groin, was less than three minutes. I'm not real clear on how we got the patient from the bed to the gurney; all I remember distinctly is that two pairs of hands came down atop my fist as we did a sheet transfer, keeping the bleeding under control.

I work with the best people on the planet. Maybe six words were exchanged during this whole drama, terse instructions on moving the patient and a count of "One...two...three" as the transfer happened.

And yes, it is just like it looks on TV. Jogging down the hallway of the basement, the fluorescent lights making stripes of brightness in the dark, one person bagging the patient as others push the stretcher, and me, fist sunk up to the wrist in somebody's bleeding body.

I remember it as a series of snapshots that got dropped into the film of my otherwise-routine night: the resident's face as he realized what had happened. The attending's expression as she scrubbed in for an emergent bypass. The intensely concentrated look of the respiratory therapist as she loped at the head of the stretcher, watching the monitor for oxygen saturation. The sight of my glove, now loose and filled with blood, as I pulled it off over a sink.

The OR manager looked at me funny when I asked him for a key to the scrubs cabinet. "Why do you need scrubs?" he asked. I looked down and realized that, aside from a few spots on my shoes, I had not gotten a drop of blood on my uniform. I do not know how.

The sight of clean ciel blue scrub pants over slightly bloodied Nikes was more unreality than I could handle. I sat down, hard, and breathed deeply for a few seconds before I went back up to the floor.

The patient will be fine. The bypass went well, transfusions over the next couple of days will take care of the blood loss, and the abscess--which had gone deeper than anybody had suspected--is now drained.

So am I.

20 comments:

Molly said...

Jebus H. Christ, I could NOT do what you do.

AtYourCervix said...

Good Save!!

me said...

Yikes!!!

lostonthefloor said...

*crosses self* Of all the angio's I've taken care of... oh, never mind don't want to jinx myself.

Lots of bloody angio sites, usually just oozers, but it's never good when you enter a room after getting paged and see family with gloves on fist deep into Dad's groin saying, "Well he started bleeding again." And for some reason I always got the angio patients with bleeding disorders.

Strong work sister!

anonymousRN said...

I'm going to be keeping a closer eye on my angio sites after hearing this story... Woah. I'm glad that all went well!

Chef Green said...

WOW. That's incredible...what a night. And what a nurse.

messymimi said...

You are amazing.

I have been in that situation twice, bleeding and no one knowing, and had to call for help.

Great nurses make all the difference.

Da Blog said...

wow, great post. I can visualize it all.

Andrea said...

Dude, What. The. Fuck. We had almost that exact same situation yesterday at work. Bleeding groin. Ours was venous (thank God), but blood was everywhere and we got to use the rapid infuser. It helps when they're already intubated and sedated, huh?

Then, because I'm a glutton for punishment, I d/c'd the Swan and radial A-line on my patient who was cooking a low-grade DIC, and while the groin did fine (thank God, again), the art site squirted through a pressure dressing.

Full moon? Mercury in retrograde? What a bloody week.

I would love to work a few shifts with you. Wish I could teleport you to my little corner of the world (day shift, too!).

Christine said...

Exciting... thanks for sharing in such great detail! =)

woolywoman said...

rock on, girl!

Helen said...

Amazing!

Maha said...

Great save! I could feel my heart racing as I read that post so I can only imagine how you felt.

Nurse Corrie said...

I had a fem-pop bypass blow open once. The patient called my name, weakly, I walked in and found her, the bed, the floor, the wall... all covered with blood. I am a PCU nurse and we don't often rush people to the OR, and she was awake(once we got the bleeding slowed and her bp back up, that is) and freaking out the whole time. Trying to keep a patient calm while your hands are in her leg, not so fun. Riding on the bed holding pressure as we rushed her to the OR was an experience that I will never forget.

danielle said...

Wow - was his guardian angel working over time or what! WTG girl! Reminds me of my experience in my last weeks of nursing school - the #1 place I did not want to do charge experience was cardio anything so of course I drew the step down unit....and the nursing student standing at the pt's door calling for help cause the pt was bleeding....and all I could say as I ran like a bat outta you know where down the hall was - you couldnt think to put pressure on it?? Followed by - call the REAL charge nurse NOW as I jumped on the bed to put pressure on the site....afterwards all I could think of was how many more days of this do I have??? LOL! Never wanted to do cardiac anything ever since!!!!!

Penny said...

I'm scheduled to donate blood again next week. I will think of you, and say and extra prayer of thanks that you exist.

I love you.

CCSutton said...

you're amazing.

ThirdDegreeNurse said...

Good job, Jo! About as good as the time I had to do the CPR on the guy who perfed a bowel and was seizing while vomiting stool. Nice save!

Bulrush said...

I'm not familiar with angios. Was the abscess on the aorta? A femoral artery?

"I don't know if they lick their catheters clean between cases, or what."

Classic, that.

medrecgal said...

Yikes!! As someone who had a type of angiography procedure not terribly long ago, that was rather gruesome in it's descriptiveness. But that comment about the catheters was still sort of funny,in a morbid, twisted kind of way! Fortunately those who participated in my procedure were kick-ass like you and that would never have happened. I will be returning for more...my curiosity has been piqued!