Sunday, March 9, 2014

A side of blood plz

Came onto shift today and this is what I found:

CBI (continuous bladder infusion) that is seriously dark pink and running almost wide open
Epistaxis (bloody nose)
Leukocytosis (UBER high WBC) - as in 22 (norm = 3.5-11) - WAS at like 70!
Anemia (seriously low RBC) - as in sitting at 91 (norm= >124)
Platelets - were seriously low but I don't remember the value

Now I can handle all this - so long as my pt isn't symptomatic....

HA as if that's possible with me!

Vitals looked like this...
T - 36.3
P - 67
R - 20 & non labored
BP - 156/87
O2 - 100% on room air

Ok well all is good except that BP - so off I go to the Dr and let her know it and ask her for an antihypertensive, and get an order for a one time dose of it. I'm ok with that since I realize that his BP is elevated because his body's TRYING to compensate for the blood loss that's occuring. Give that to him at dinner time and when I do I notice that he's huffing and puffing. Off I go to get my trusty machine to find out his O2 has dropped to 94% in just 2 hours! (During that time as I was going in and out of his room he was pulling saturated kleenex packing out of his nare and blood clots to boot) Well when I saw that value I was a bit peeked - off I go to call the on-call Doc and got an order for a CBC (complete blood count) to find out what his Hgb (hemaglobin/RBC) is. Let him know I'll keep him informed....

ENT comes to the floor and puts a piece of material on the spot he thinks is causing the bleeding (personally disagreed with him because he was bleeding down the back on his throat and pulling clots out his mouth so I thought that it would be pretty high up) and he thought that that would do the trick. Well it did for about 1 hour - then it started POURING out his nose!!! Like a bloody seive! I freaked a bit inside because there wasn't anything I could do to help really.

Get the CBC result back and it's the same as in the morning so I heaved a HUGE sigh of relief because at least I wasn't giving blood on MY shift. But I called the on-call again to let him know the value but that it was POURING blood out his nose and saturating packings like crazy. He came to assess him again and this time suggested a TAMPON packing.

So that's exactly what I did. I called ER and had them send me the tampon packing and I shoved that sucker up his nose. It expanded and made his eyes water - felt bad for that part. It hurts having things shoved up your nose! Gave him some hydromorphone, let it sink in and shoved ANOTHER one up there since he was still getting clots out the back of his throat - figured that one more wouldn't hurt and might clog up enough to stop the clots going down his throat from his nose.

I'm back tomorrow, I bet he gets blood tomorrow - either on days or on my shift. Hopefully they'll do something more with his bleeding. Oh and they have NO clue why he's bleeding in his bladder and haven't scheduled any sort of test for it.

His leukocytosis bit they believe has to do with an infection of his spine so he's in an aspen collar (neck brace) which means I can't even roll this guy onto his side (sort of in the recovery position) and let the blood drain into his mouth sort of thing. Totally anxious about aspiration - had to put him in high fowlers - don't know how he's going to sleep tonight if this bleeding doesn't stop! I guess we'll see tomorrow!

Of course this isn't the only thing going on - I also had an admission, another pt was confused to the point that he forgot about his IV and got out of bed to urinate (into a urinal!) and pulled out his IV - so I had to take the time to resite that and his veins are shot so it took me even longer! Ya I didn't leave until 1:30am! ARG, oh to be back to work!!!!!!!

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