A 60-year-old man was brought in by ambulance; they walked him in. He complained of "not feeling well" with some dizziness and nausea that had been going on for a few weeks. There were some suspicious stains on the front of his shirt.
When asked about his medical history, he said, "I've never been sick a day in my life, and I've never been to a doctor." He told me he didn't smoke, and "had a few drinks" every day.
You can see where this is going, right?
As I was finishing up his triage, he said he felt like he was going to vomit. I gave him a basin, and URP! Up came almost a liter of blood and blood clots. I called for some help and immediately started placing a large-bore IV.
I asked him if he had ever vomited blood like this before, and he said yes, all the time. When I asked him if this worried him, he said no--"because I always feel better after I vomit!" and then he asked to go home.
Yeah, that's not going to happen. (btw, his hemoglobin was 5.2. Oh, and those "few drinks"? A liter of vodka every day after work.)
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8 comments:
He just needs to walk it off, he'll be fine. Tell him to man up.
Nice!
Bet that pleasantly plump belly was ascites, and that healthy glow was jaundice, too. ;)
I became a corrections nurse recently. It's amazing...no call lights, and I usually only see people when the officers feel like opening the door to the cell.
The only people who get narcs are the ones who have had surgery, or who have a fracture (of course from another prisoner stomping them).
Shitty customer service is not only part of the culture, it is expected....a whole new world....think about it...LOL!!!
Ewww.....did he have esophageal varices that ruptured? I had a patient like that once and we sent him to the ICU. That darn ETOH will do it too ya! Nice ER story!
Sarah RN
Argh! I can't imagine that kind of nonchalance about puking blood. I have a disorder that causes bleeding during its flareups, and I know how ROTTEN I felt when my hemoglobin was 7.3, so he must have been walking around through sheer obstinance.
At least you didn't send him up to the floor telling the floor nurse there wasn't much wrong with him, he was just a complainer. That's how I was introduced to my first vomiting massive amounts of blood patient. I was trying to do her admission before calling the doctor to tell him she was complaining of feeling awful in her stomach, when she open her mouth and sprayed me, the bed curtain, bedspread, floor, wall...she was on coumadin, the doctor told her not to take aspirin or ibuprofen...but didn't mention Aleve (naproxen). My conversation with the doctor went like this: Me "She's vomiting blood, with clots." Doctor "She's vomiting blood? With clots? " Me "Yes, she's vomiting blood, with clots, a lot of it." Doctor,"She's vomiting blood, with clots?" Me "YES, SHE'S VOMITING BLOOD WITH CLOTS!" Doctor, "Well, why isn't she in ICU?" Me, (thinking "Because you didn't order her to be sent there.") saying "Ok, we send her to ICU now, any other orders?" I was a pretty new nurse when this happened. All I could think was how glad I was I hadn't put off doing her admission paperwork, because I would have been in big trouble transferring a patient I hadn't admitted yet. She did make it in ICU, but just barely.
Now I'm not a Nurse, I'm an EMT but my first experience with a patient vomiting massive amounts of blood happened when we got a call to a home for a patient vomiting blood. We walk in and he has this huge bucket 3/4 of the way full of blood, barely a blood pressure, so scoop and run. He tries talking in the ambulance, and suddenly turns his head away from the paramedic and proceeds to SNEEZE. COVERING all the equipment, cabinets, and bench on that side of the ambulance with blood. Needless to say it took me an HOUR to clean up all the blood out of my ambulance and off my equipment.
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