Re: Re: Interesting Patient

[Guest guest]

must be something about orientation. Our new nurse (new grad at that) was

helping with a spinal and it went up the girl ended up on a vent with an

emergency section. We seem to have our failure to progress sections at 7pm

also just in time to change shifts (we do our own sections they don't get

sent to OR)

[Guest guest]

yikes!!!!!!!!!! sue

[OBnurses] Re: Interesting Patient

Hi, well we had a young nurse participate in one of those thankfully rare OB emergencies...the patient was a 44 year old g2p1 who had a Cesarean for failure to progress (and a nasty looking strip!). The Cesarean went smoothly, and the patient was transferred to recovery without incident...45 minutes into the recovery, the patient made a sound and the nurse, thinking she was throwing up, turned to get the emesis basin, and discovered the patient was having a grand mal seizure. She immediately called for help of course, and two more nurses ran in and made sure that the patient wasn't hurting herself, O2, ambu, etc (of course the seizure has to run its course)...anesthesia came running, the OB was called and came running...Mag bolus started etc etc. The patient was post-ictal afterwards and had no recollection of what happened to her...but basically was fine...The patient had absolutely no symptoms of pre eclampsia: normotensive throughout, no headache, blurred vision, etc etc, very little edema, no proteinurea, nothing! She underwent an MRI and they discovered that she had had an AV malformation, and would have to have either radiation or surgery, according to our neurologist... Well we did a little post traumatic stress disorder therapy with the young nurse, who performed very well...and allowed her to vent and cry and shake afterwards! (Of course we were secretly glad it wasn't our patient!!! lol) As for pushing, we expressed to the neurologist that she would have been in great danger had she pushed for this delivery, and he said that studies showed that pushing during vaginal delivery had little or no effect on these AVM's...we were amazed at that one!!! All of this is heresay from my coworkers, by the way. Where was I? In my patient's room doing AM care and missing the entire thing!!! PS Two months ago, the same young nurse was involved in a cord prolapse with her patient as well, and performed equally admirably! We told her she was getting this stuff out of the way early in her career! Welcome to the OBnurses list!You have the freedom to change your membership settings at any time you choose. Go to the Yahoogroups Home Page at www.yahoogroups.com and sign in with your e mail address and the password you used to subscribe to this list. You will then see a list of all Onelist lists you are subscribed to. You can then easily choose the settings you would like--unsubscribe, digest, or Web-only.

[Guest guest]

Wow how scary!!! Sounds like this poor nurse is learning some quick thinking skills the hard way!!! Strange about the fact that pushing would have been okay..?? Was her first baby vag?

sue may

[OBnurses] Re: Interesting Patient

Hi, well we had a young nurse participate in one of those thankfully rare OB emergencies...the patient was a 44 year old g2p1 who had a Cesarean for failure to progress (and a nasty looking strip!). The Cesarean went smoothly, and the patient was transferred to recovery without incident...45 minutes into the recovery, the patient made a sound and the nurse, thinking she was throwing up, turned to get the emesis basin, and discovered the patient was having a grand mal seizure. She immediately called for help of course, and two more nurses ran in and made sure that the patient wasn't hurting herself, O2, ambu, etc (of course the seizure has to run its course)...anesthesia came running, the OB was called and came running...Mag bolus started etc etc. The patient was post-ictal afterwards and had no recollection of what happened to her...but basically was fine...The patient had absolutely no symptoms of pre eclampsia: normotensive throughout, no headache, blurred vision, etc etc, very little edema, no proteinurea, nothing! She underwent an MRI and they discovered that she had had an AV malformation, and would have to have either radiation or surgery, according to our neurologist... Well we did a little post traumatic stress disorder therapy with the young nurse, who performed very well...and allowed her to vent and cry and shake afterwards! (Of course we were secretly glad it wasn't our patient!!! lol) As for pushing, we expressed to the neurologist that she would have been in great danger had she pushed for this delivery, and he said that studies showed that pushing during vaginal delivery had little or no effect on these AVM's...we were amazed at that one!!! All of this is heresay from my coworkers, by the way. Where was I? In my patient's room doing AM care and missing the entire thing!!! PS Two months ago, the same young nurse was involved in a cord prolapse with her patient as well, and performed equally admirably! We told her she was getting this stuff out of the way early in her career! Welcome to the OBnurses list!You have the freedom to change your membership settings at any time you choose. Go to the Yahoogroups Home Page at www.yahoogroups.com and sign in with your e mail address and the password you used to subscribe to this list. You will then see a list of all Onelist lists you are subscribed to. You can then easily choose the settings you would like--unsubscribe, digest, or Web-only.

[Guest guest]

CPD cases: cesarean prior to dinner.

That is too funny. Unfortunately, usually the docs get their dinner before us!!!!

Lori

[Guest guest]

I call those true CPD cases: cesarean prior to dinner.

From Cassioo: " We seem to have our failure to progress sections at 7pm "

[Guest guest]

In a message dated 9/4/01 3:07:46 PM Central Daylight Time,

flygal412@... writes:

<< I call those true CPD cases: cesarean prior to dinner.' >>

I like that

[Guest guest]

--- " Hamilton "

wrote: 'I call those true CPD cases: cesarean prior to dinner.'

and all,

It's nice to know some things never change . . . I mean I haven't done any OB,

other than the occasional drop in ER delivery or high risk transfer since 1989,

but even I still recall those CPD sections. Gee, should that be comforting or

scary?

Best to all,

==

Bennetsen

RN BSN CFRN CEN CCRN EMT-P

L & M Consulting and Education

San , TX

" Excellence in Medical Legal Review and Nursing Education "

_____________________________________________________________

Nursefriendly National Consumer & Health Directories.

Over 100,000 Nurse Reviewed & Approved Websites & Nursing Entrepreneur

Directories.

http://www.nursingexperts.com

http://www.nursingentrepreneurs.com

http://www.nursinghumor.com

[Guest guest]

First baby was vag, no probs!

[Guest guest]

The severity of the decelerations were in direct proportion to the time of day." :

That's like our favorite saying "the fertility factor is inversly proportionate to our clients IQ" Lori

[Guest guest]

We had a crash section 2 weeks ago for a twin demise. Mom came in Sunday for an NST which was reactive @35 weeks, then in the office Monday she had elevated bp..they sent her for a biophysical profile and they found B twin was a demise. The umbilical cord was like a spiderweb where it inserted into the placenta and had started to pull away from the placenta.

Had the cord separated any more it could have been a terrible 3 person tragedy. Twin A was hypovolemic, but did fine after a bolus of saline and an overnite in scn,,,it was so sad for these parents tho to have a newborn and plan a funeral.

[Guest guest]

OMG! If this isn't true, I don't know what is!

Gay Marie Callahan

Re: [OBnurses] Re: Interesting Patient

"The severity of the decelerations were in direct proportion to the time of day." : > Sandy

[Guest guest]

Heck, not only do most of the docs get dinner before the nurses, the nurses often don't get dinner at all!

----------Jeanine

Re: [OBnurses] Re: Interesting Patient

CPD cases: cesarean prior to dinner. That is too funny. Unfortunately, usually the docs get their dinner before us!!!! Lori Welcome to the OBnurses list!You have the freedom to change your membership settings at any time you choose. Go to the Yahoogroups Home Page at www.yahoogroups.com and sign in with your e mail address and the password you used to subscribe to this list. You will then see a list of all Onelist lists you are subscribed to. You can then easily choose the settings you would like--unsubscribe, digest, or Web-only.

[Guest guest]

This thread on "Interesting patients" reminds me of a non stress test patient I got while assigned to the non stress room during my shift (we did sometimes 20 or more NST's per shift in addition to a full floor of high risk antepartums.).

This girl came in sort of as a "routine" NST though during my "admission" questions, she admitted (only after being asked though--which shocked me!) that she hadn't felt the baby move *at all* in 3 days! I began the NST, and saw a tracing that looked like--no exaggeration ------------------------------------------

After a minute of this, and NO activity with stimulation, I called the doc, who initially thought I was referring to decreased variability. HA! Talk about "NO variability!" Never seen anything like this, even in the worst distress. Steady--frighteningly so--fetal heart rate at 130 BPM. The patient was immediately sent to ultrasound, when I heard a code 9. Yup--my patient had had a massive cardiac event complete arrest. She was rescusitated though comatose, and the fetus *still* had a heartbeat, though deadly even. The patient obviously couldn't be sectioned, nor was she in labor, nor was she stable to labor. She went to CCU, where the nurses there had a horrible time dealing with the fact that the fetus was still alive in utero, but was dying. The baby died about 48 hours later--that was just awful to see it happen and yet not be able to do a darn thing. Beautiful full term baby girl.

Surprisingly enough, this mom survived, though with about 30 percent cardiac function, and even had another child.

Although none of us ever would have said this to her, none of us could understand how an apparently loving non drug using pregnant woman could NOT feel their baby move and NOT report it before 3 days pass!

----------Jeanine

Re: [OBnurses] Re: Interesting Patient

All this talk reminds me of a saying at a teaching hospital I used to work at concerning decelerations. Since I worked the night shift, we watched some pretty ugly strips while the resident and attending slept - yet would come back to recovering sections for average decelerations. We used to say "The severity of the decelerations were in direct proportion to the time of day." : > Sandy Welcome to the OBnurses list!You have the freedom to change your membership settings at any time you choose. Go to the Yahoogroups Home Page at www.yahoogroups.com and sign in with your e mail address and the password you used to subscribe to this list. You will then see a list of all Onelist lists you are subscribed to. You can then easily choose the settings you would like--unsubscribe, digest, or Web-only.

[Guest guest]

I don't understand why she couldn't be crash sectioned. I have witnessed crash sections, one for mom having an amniotic fluid embolism, and the other for the mom having an MI. Another crash section I witnessed was for a prolapsed cord. By "crash" I mean no anesthesia...just cut. Then, I've seen sections after mom was declared dead (one of these made the national news Memorial Day 2000).

In the case of the amniotic fluid embolism, we were treating her, she arrested within minutes, we took her to the OR while the code was still being run, and we cut. Unfortunately, neither the mom or baby made it. She was my friend. The baby was buried in her arms in the shared casket. She was an RN that I worked with when I first started out in nsg on Neuro. So sad.

In the case of the MI, mom arrested, we cut while the code was being run. Outcome was excellent for both. Although, mom eventually required a heart transplant. At least she lived to have the chance to have the transplant.

I won't go into detail about the crash section for the prolapsed cord except to say that mom was fully awake, no OR crew or anesthesia was available, there was no longer a pulse coming through the cord at all. She is an ER RN (also my friend), knew what was going on, her husband (a State Trooper) held her in his arms, and we cut. Period. The outcome was excellent for both. Although, I did have to work on the baby for a bit to get a heartbeat and respirations. If we hadn't cut, if we had waited for anesthesia and the crew to arrive (the neonatal code was in progress as they began arriving), these parents would not have a perfect, beautiful four year old daughter right now. They are grateful, gave a type of permission (verbal), and do not regret what happened.

As to the others...moms were declared dead and kept "alive" via CPR until we could get them, confirm the death, and try to save the baby. The baby that made the nat'l news on Memorial Day 2000 should never have been "saved" and was finally taken off all life support around Labor day 2000. We've had other babies make it after mom is declared dead, but this one was all wrong from the beginning.

I can't help but think that the mom you referred to would have had a better fighting chance if the baby had been delivered so her body could focus on recovering itself.

Gay Marie Callahan

Re: [OBnurses] Re: Interesting Patient

.. The patient was immediately sent to ultrasound, when I heard a code 9. Yup--my patient had had a massive cardiac event complete arrest. She was rescusitated though comatose, and the fetus *still* had a heartbeat, though deadly even. The patient obviously couldn't be sectioned, nor was she in labor, nor was she stable to labor.

[Guest guest]

In a message dated 9/4/01 9:14:05 PM Central Daylight Time,

kemper1974@... writes:

<< That's like our favorite saying " the fertility factor is inversly

proportionate to our clients IQ " >>

I " ve always said yes and I have to have a liscense for my dog

[Guest guest]

You may be right, Gay MArie, that she may have had a better chance if the baby was crash sectioned. Honestly, I don't know. It may have had something to do with the hospital being a Catholic Hospital, and the mom's life was considered more at risk if she had surgery then, and the Catholic Hospital won't risk mom to deliver a baby.

----------Jeanine

Re: [OBnurses] Re: Interesting Patient

.. The patient was immediately sent to ultrasound, when I heard a code 9. Yup--my patient had had a massive cardiac event complete arrest. She was rescusitated though comatose, and the fetus *still* had a heartbeat, though deadly even. The patient obviously couldn't be sectioned, nor was she in labor, nor was she stable to labor. Welcome to the OBnurses list!You have the freedom to change your membership settings at any time you choose. Go to the Yahoogroups Home Page at www.yahoogroups.com and sign in with your e mail address and the password you used to subscribe to this list. You will then see a list of all Onelist lists you are subscribed to. You can then easily choose the settings you would like--unsubscribe, digest, or Web-only.

[Guest guest]

OH MY GOSH!!!! I have never heard of that...ouuuuuchhh!!!! I guess I am fortunate that we have an Anesthesiologist in house absolutely at ALL times...just for OB. We had a patient in our testing dept. once, the doc was doing an amnio and accidentally nicked a tiny blood vessel of the placenta. The strip was classic sinusoidal...then we rushed to the back for a section. We were still pulling her jeans down as they were cutting, as the mask was being placed over her face for general anesthesia. When you look at the strip and then time of delivery, 7 minutes total even including transporting her across the hall and to the OR..The baby almost completely bled out, needed several transfusions but ended up okay. She was 36 weeks, they were doing the amnio for a L/S ratio to see if they could deliver. Mute point then huh...?

sue

Re: [OBnurses] Re: Interesting Patient

.. The patient was immediately sent to ultrasound, when I heard a code 9. Yup--my patient had had a massive cardiac event complete arrest. She was rescusitated though comatose, and the fetus *still* had a heartbeat, though deadly even. The patient obviously couldn't be sectioned, nor was she in labor, nor was she stable to labor. Welcome to the OBnurses list!You have the freedom to change your membership settings at any time you choose. Go to the Yahoogroups Home Page at www.yahoogroups.com and sign in with your e mail address and the password you used to subscribe to this list. You will then see a list of all Onelist lists you are subscribed to. You can then easily choose the settings you would like--unsubscribe, digest, or Web-only.

[Guest guest]

Not having 24 hour in house anesthesia services is the only true downside to working where I work now. That would be the only thing that would improve the services we provide. The one good thing I learned from my tertiary care experience was that it sure was nice to have 24 hour in house OR services.

Gay Marie Callahan

Re: [OBnurses] Re: Interesting Patient

.. The patient was immediately sent to ultrasound, when I heard a code 9. Yup--my patient had had a massive cardiac event complete arrest. She was rescusitated though comatose, and the fetus *still* had a heartbeat, though deadly even. The patient obviously couldn't be sectioned, nor was she in labor, nor was she stable to labor. Welcome to the OBnurses list!You have the freedom to change your membership settings at any time you choose. Go to the Yahoogroups Home Page at www.yahoogroups.com and sign in with your e mail address and the password you used to subscribe to this list. You will then see a list of all Onelist lists you are subscribed to. You can then easily choose the settings you would like--unsubscribe, digest, or Web-only.

[Guest guest]

Not having 24 hour in house anesthesia services is the only true downside to working where I work now. That would be the only thing that would improve the services we provide. The one good thing I learned from my tertiary care experience was that it sure was nice to have 24 hour in house OR services.

Gay Marie Callahan

Re: [OBnurses] Re: Interesting Patient

.. The patient was immediately sent to ultrasound, when I heard a code 9. Yup--my patient had had a massive cardiac event complete arrest. She was rescusitated though comatose, and the fetus *still* had a heartbeat, though deadly even. The patient obviously couldn't be sectioned, nor was she in labor, nor was she stable to labor. Welcome to the OBnurses list!You have the freedom to change your membership settings at any time you choose. Go to the Yahoogroups Home Page at www.yahoogroups.com and sign in with your e mail address and the password you used to subscribe to this list. You will then see a list of all Onelist lists you are subscribed to. You can then easily choose the settings you would like--unsubscribe, digest, or Web-only.

[Guest guest]

How many of you find that it's the patient that comes in for "decreased fetal movement" that has the best looking NST's?! I always tell my patients (I am a CBE as well as an L & D RN) to listen to their bodies. Had a first time mom come in complaining of "something's wrong"...denied bleeding, decreased movement and all the other questions that we ask. Her mother was with her saying "....I keep telling her she's just nervous". Put her on the monitor and the baby was in the 60's...went down to 30's...within minutes we were in the OR. Perfectly healthy baby with it's cord in it's fist!!!!

[Guest guest]

How many of you find that it's the patient that comes in for "decreased fetal movement" that has the best looking NST's?! I always tell my patients (I am a CBE as well as an L & D RN) to listen to their bodies. Had a first time mom come in complaining of "something's wrong"...denied bleeding, decreased movement and all the other questions that we ask. Her mother was with her saying "....I keep telling her she's just nervous". Put her on the monitor and the baby was in the 60's...went down to 30's...within minutes we were in the OR. Perfectly healthy baby with it's cord in it's fist!!!!

[Guest guest]

we're getting into an anthesia crunch. The head of the dept is quitting to

go traveling MD. The assistant was online looking for a replacement and

found a job from his home state open and it's a friend of his that's the head

of dept there so he's leaving 10/15 and one of our CRNA just left to travel

d/t problems at home he's since come back PRN. But the ones leaving are some

of the best. Might need to go back to school for CRNA LOL yea right.

[Guest guest]

Even before I was a nurse ll years ago when I was pregnant with my first, I was hypertensive at the end of the pregnancy, and taking it very easy, and thank goodness I knew enough to pay attention to the babys movement, it was christmas day eve, had a nicemellow dinner with my husbands family etc, ll pm i noticed that baby was very quiet, tried the usual trick of eating "captin crunch cereal" and that usually got her moving all over the place and it didnt really do it, felt funny about calling the dr so late on that particular night being a holiday and all, but he told me to go in to L & D and get an nst.......and we went right away, I was sectioned four hours later, for variable and late decelerations.....my baby was in some trouble...and during the section she had thick mec,cord wrapped tightly around her foot. She spent three days in nicu...transient tachypnea,etc...

Im just glad that I learned to listen to my instincts, I hear things at work like what you described and im ALWAYS amazed that people dont get that something is wrong....

I have a terriffic ll year old daughter, Im glad!

sue

Re: [OBnurses] Re: Interesting Patient

All this talk reminds me of a saying at a teaching hospital I used to work at concerning decelerations. Since I worked the night shift, we watched some pretty ugly strips while the resident and attending slept - yet would come back to recovering sections for average decelerations. We used to say "The severity of the decelerations were in direct proportion to the time of day." : > Sandy Welcome to the OBnurses list!You have the freedom to change your membership settings at any time you choose. Go to the Yahoogroups Home Page at www.yahoogroups.com and sign in with your e mail address and the password you used to subscribe to this list. You will then see a list of all Onelist lists you are subscribed to. You can then easily choose the settings you would like--unsubscribe, digest, or Web-only.

[Guest guest]

What a good thing you DID listen to your instincts!

It seems like for every 100 moms that come in cuz they aren't feeling their baby move as much, maybe two might really be having a prob. That's not scientific, just a guess, based on what I see. So, if we help those two, then we have done our jobs. Even though, almost all of the time, it turns out to be nothing, finding the something [wrong] makes it worthwhile to screen out all the rest.

I'm glad you were one of the ones who listened to your instincts and followed through.

Gay Marie Callahan

Re: [OBnurses] Re: Interesting Patient

Even before I was a nurse ll years ago when I was pregnant with my first, I was hypertensive at the end of the pregnancy, and taking it very easy, and thank goodness I knew enough to pay attention to the babys movement, it was christmas day eve, had a nicemellow dinner with my husbands family etc, ll pm i noticed that baby was very quiet, tried the usual trick of eating "captin crunch cereal" and that usually got her moving all over the place and it didnt really do it, felt funny about calling the dr so late on that particular night being a holiday and all, but he told me to go in to L & D and get an nst.......and we went right away, I was sectioned four hours later, for variable and late decelerations.....my baby was in some trouble...and during the section she had thick mec,cord wrapped tightly around her foot. She spent three days in nicu...transient tachypnea,etc...

Im just glad that I learned to listen to my instincts, I hear things at work like what you described and im ALWAYS amazed that people dont get that something is wrong....

I have a terriffic ll year old daughter, Im glad!

sue

[Guest guest]

What a good thing you DID listen to your instincts!

It seems like for every 100 moms that come in cuz they aren't feeling their baby move as much, maybe two might really be having a prob. That's not scientific, just a guess, based on what I see. So, if we help those two, then we have done our jobs. Even though, almost all of the time, it turns out to be nothing, finding the something [wrong] makes it worthwhile to screen out all the rest.

I'm glad you were one of the ones who listened to your instincts and followed through.

Gay Marie Callahan

Re: [OBnurses] Re: Interesting Patient

Even before I was a nurse ll years ago when I was pregnant with my first, I was hypertensive at the end of the pregnancy, and taking it very easy, and thank goodness I knew enough to pay attention to the babys movement, it was christmas day eve, had a nicemellow dinner with my husbands family etc, ll pm i noticed that baby was very quiet, tried the usual trick of eating "captin crunch cereal" and that usually got her moving all over the place and it didnt really do it, felt funny about calling the dr so late on that particular night being a holiday and all, but he told me to go in to L & D and get an nst.......and we went right away, I was sectioned four hours later, for variable and late decelerations.....my baby was in some trouble...and during the section she had thick mec,cord wrapped tightly around her foot. She spent three days in nicu...transient tachypnea,etc...

Im just glad that I learned to listen to my instincts, I hear things at work like what you described and im ALWAYS amazed that people dont get that something is wrong....

I have a terriffic ll year old daughter, Im glad!

sue