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: Source Type: blogs