WTF OR?!

To hand someone over that is basically dead and say that they are only hemodynamically unstable in not OK.

We knew that we were getting a patient who went from our sister hospital's ER and transferred to our hospital's OR for emergent surgery. We were told that this person required massive blood transfusions - weren't told what they received but that the code for the massive blood transfusions was cancelled - making us believe that the person we were getting was stabilized. I told everyone that it was going to be a "gong show".

We tried to look up in the system something about this person because all we knew was that they were really young and they had an inferior vena cava filter and that it had eroded there and the pt was bleeding. We knew that clearly this person had other shit going on if they were that young and required this. The crazy thing is that the chart had NO information from doctors from the last four days worth of ER visits! No information listed to blood work that was done over the last couple of days. How in the world could this person not have ANY blood work any of the previous days considering they were on blood thinners and had this filter in place. You would think that they would do blood work (BW) - such a basic thing. On the fourth day they finally did and their INR was 12!!!!! Oh, and their Hgb was 30!!! Shame on the ER for not doing BW on any of the other days, they for sure would have caught things declining a whole lot sooner.

I was the assist nurse that shift, helping those who received admissions. The nurse had indicated that they hadn't done an admission yet - surprising cuz this person had been there longer than I. So I advised them that when the OR called to ensure that a proper report was given because often they will just tell us that they are coming and asking whether we're ready. So I told her to make sure that she found out what state that this person was in. I advised her to find out what meds that this person was on because I absolutely believed that this patient would be on meds to support their BP, guaranteed and you don't want to be chasing your tail when they arrive, trying to get these meds infusing while trying to settle your patient. For some unknown reason the pumps they use in the OR is different than the ones used in the rest of the hospital. Therefore it was pertinent to find out the meds they were on so that they could be ready to change over to our system. Of course I was right when they called and advised that they would be coming in 10-15 min and then subsequently hung up. The nurse, listening to me, called them back and received a proper report.

When the OR people brought the patient to us the lines were a mess! While myself and another nurse were getting things sorted out and attached to our cardiac monitor, I pulled all the blankets off and saw that they had two intraosseus (IO) and several peripheral IV lines and then a single lumen central line (SLIC) - and they had pressors running but no blood or even IV fluid. The pt also had a art line showing their BP and when attached to our monitoring system we could see immediately that the art line BP was seriously low => something in the area of 50/25.... not enough to sustain life for sure. And the nurse asked the anethetist WTF and was told that the art line wasn't accurate so a BP cuff is quickly put on and the BP was basically unchanged - so immediately the ICU Dr asks for a pulse check.... nope, no pulse and so we immediately start coding this pt.

We restarted the massive transfusion protocol and start pumping fluids in, hoping that we can revive this person. Sadly we coded this person for quite a long time and couldn't get them back.

Now I'm left with the feelings of this whole situation. I don't understand why the OR would cancel the transfusion code... did they even check pulses before sending us this person. Were they just trying to offload this person on the ICU so that they could be relieved of the fact that this person did NOT die in the OR?!

We had a debrief after TOD was called. We talked through this all. We talked about how hard it was for information to be found about this person's current medical condition and any recent blood work. We couldn't understand how the OR did NO blood work while the patient was in the OR. Why would they cancel the transfusion protocol if they had no numbers to back up cancelling it. They had NO idea what this patient's Hgb/Hct was when they brought them to us in the ICU.

ICU didn't stand a chance of saving this person because so many people before us failed this person. To learn that this person just celebrated their birthday and then to learn that they were a refugee made this death even worse. Such a short life to be cut short when so many other steps could have been taken to save this person.