How Nurses Save Lives (and make surgeons look better)
I had seen the lady in the ED at around noon. She presented with a 1 day history of non specific crampy abdominal pain and nausea/vomiting. The CT demonstrated a garden variety small bowel obstruction (SBO), likely related to adhesions from a hysterectomy from years ago. Her labs were all normal and her belly exam was not especially impressive. Nonetheless, I placed an NG tube and admitted her to the hospital for close monitoring.
In over 70% of cases, an SBO will resolve on its own just with nasogastric decompression, bowel rest, and appropriate hydration. Typically we will initiate a trial of conservative therapy in these cases. Lack of progress or outright worsening over the next 24-72 hours then warrants operative exploration.
I checked on the lady again at around 5:30. She seemed about the same. She had some mild LLQ discomfort but no peritoneal signs. I reviewed the films again. Her WBC was totally normal, without even a left shift. I ordered another set of films for the next morning.
I then received a page from the nurse at around 10:30 that night.
-Dr Parks, I don't like what's going on with Mrs X
-No? What's up, I said
-She won't stop screaming. In pain. I gave her dilaudid last hour but it didn't touch her.
-That's strange. Screaming?
-Yes. You can hear her out in the nurse's station. It's bothering the other patients.
-Ok. Send...
Source: Buckeye Surgeon - Category: Surgeons Authors: Jeffrey Parks MD Source Type: blogs
More News: Back Pain | Hospitals | Hysterectomy | Nasogastric Intubation | Nurses | Nursing | Pain | Surgeons