Dropped Blood Pressure

Last night I helped the resident pull a sheath out of a patient's left femoral artery after his angiogram. 20 minutes later I noticed the systolic pressure was 86. This isn't too alarming by itself if his pressure was normally in the 90's, as he needed a little morphine to be able to tolerate the sheath pull. But his pressure had been running in the 130-150's, so this was trouble. I grab another nurse and have her head down to the room while I print out the vitals and page the resident before I join her.

There it was....a large hematoma at the site where we had just pulled. Trouble. How much had he bled? How much loss could he tolerate? I have the secretaries at the desk now STAT page the doctor, and I apply pressure. Other nurses join us, and we start pumping fluid in, squeezing the bag while we wait for another nurse to grab the pressure bags. The doc arrives within 5 minutes of my original page, and at this point the patient is pasty white, and his BP is 64/40. Thank goodness he was still mentating just fine. T-berg position is a wonderful thing, and thanks to 500cc of normal saline the pressure was looking up. At this point the unit of blood arrived and we quickly switched over from the fluids. BP now 96/50. T-berg put back into neutral position, then BP 110-56. Beautiful. :)

The patient was very nervous through all this, but never passed out. After everyone left and he and I were alone again while I finished the last of the 45 minutes extra pressure to the sheath site, he told me how impressed he was with the nurses, how well we worked together and got the job done in a fast and efficient manner.

All I can think about is how had I not paid attention to that monitor like I was, had I simply stepped away for a couple minutes from the monitor to check on my other post-op......I think we would have been looking at a very different situation. I'll never tell him how close it was, but wow, it was. I'm so thankful that I've always been able to catch things before they go completely bad, it's like there is a little intuitive part of you that knows something is up and makes you pay attention, even when your logical side doesn't think anything is wrong.

Love for the Ages

I have a patient today who has been married for 20+ years to his wife, who is also physically challenged in this world. He is a quadriplegic, for 29 years since he was in a car accident. The love in that room....it's almost overwhelming. She does everything for him, won't let us do anything other than tests, meds, that kind of stuff. Wow. To see two people who love each other that much and are totally devoted to each other.....it's amazing to see. Two people who have such a hard time physically in this world....yet they totally depend on each other and get through it together. Love really does conquer all.

Lentil soup

Thought you guys might like to try one of my fave recipes!! Review it as you wish!

http://www.epicurious.com/members/member_recipes/recipe_views/views/1228095

"They are coming to take me away...heehee"

True story. My patient this evening was going to a CT scan, and when I told him transport was on his way up he told me he wanted to call his son to tell him. This is how the phone call went from my view, where I could only hear one side of the conversation:

"They're coming to take me away heeheee"

"hello?"

"you aren't Mr. ____?"
"nevermind then."


I lost it just imagining what the poor person on the other end must have been thinking!! Now that is a great wrong number story.

Friggate in my view

Thought you all might like to see what I woke up to this morning in my view.
http://www.royal-navy.mod.uk/server/show/nav.1580