So, as I've mentioned before, the past weekend was pretty action-packed. We had the guy with a globe rupture, and then we got another kind of rupture.
I got report from another hospital letting me know about a transfer. This was a thirtyish woman with a two-day history of lower abdominal pain and a positive pregnancy test. She was coming from a small community hospital with no GYN services, and needed an ultrasound to rule out an ectopic pregnancy. I was told she was stable and in no serious distress.
An hour later, an ambulance rolls in with the transfer. She is paler than milk, diaphoretic, shivering; her belly is distended and painful. Because she's young and in great shape, her blood pressure wasn't terrible (yet) and she wasn't too tachycardic (yet), but it was clear that this was no stable "rule out ectopic." This was a full-blown ruptured ectopic.
Of course, we all spring into action with fluids, blood products, warming blankets, and immediately prepared her for surgery. I went up with her to the OR, and when the two GYN docs with me ran into the room to set up, I was left in the holding room alone with the patient. It was a Saturday night, so the place was empty. "Hello?" I yelled. "Is there a nurse around? I need to endorse this patient!"
I look down at the woman, and she's lying there quietly, with her eyes closed. I started attaching monitor leads so I could keep an eye on her until someone came. Suddenly she takes a deep, trembling breath in...pauses....and lets it out, her face slack.
I almost soiled myself. In fact, I think maybe a little pee might have escaped.
I grabbed her wrist to feel for a pulse, yelling, "Ma'am! Miss! Open your eyes!" as I desperately looked around for a code cart. I have never felt so alone in my life.
Fortunately she opened her eyes. "Are you ok?" I asked? She nodded. Her pulse was around 120 and thready. I started pumping up the pressure bags on all the blood and fluids that were hanging around her to squeeze out as much as I could into her. I finally noticed a nurse slowly sauntering down the hall and yelled for help. Thank goodness the docs came running out of the OR and they all took her in.
I found out later that they suctioned two liters of blood out of her abdomen, fixed the rupture, and she's in the ICU but ok and recovering.
The lesson I learned? I will NEVER go up to the OR with a case like this again without another ER nurse with me.