The ER doctor is only as good as her hospital allows, Nov 23, 2004

Continuing on with this lower GI bleed lady.

She seemed okay after the questioning...and during rounds. But immediately after rounds she seemed to be sleeping. When the sheets were pulled back... .

..she was laying in a mound of dark red clots of blood. Looked immediately up at the monitor, low and behold she was tachycardic and hypotensive. The juniors were all over it...and stabilized her with IVF, blood transfusions, and even got a tagged RBC scan to see where the blood was coming from...exactly.

The RBC scan revealed a "sprinkler" in her descending colon. Surgery was called. They wanted an NGT lavage "the bleeding may be coming from above." But we have the RBC scan...

...initially the lady refused NGT lavage, but now she was intubated and unconscious, so it was done. No blood. Surgery was reconsulted.

"You have to get GI to see this patient first, she's too unstable for the OR."

GI was called...they can't scope until the following day (maybe). There's only one attending who scopes, and he's off today. Unbeliveable!

This went on all night. Patient seemed stable overnight, and the family was informed.

A CBC was ordered by the intern overnight...but the nurse (for whatever reason) decided not to draw one. Nor did he tell the intern. So there was no CBC overnight...and when I arrived at 7am, I ordered the (new day shift nurse) to draw one. The new H/H 3/10.

What!! How did this happen??

We order blood, which takes the better part of an hour to obtain...even noncrossmatched. We give her IVF, and talk the the (very surprised and upset) family. And we wait.

We call GI back...they are in clinic doing a procedure, and will come later in the day. What??!! Hello, we have a dying patient here... Candice the student nurse wipes the patients face because there is a bit of brownish liquid on her cheek. When she pressed on the cheek with the towel...more brown stuff came from the patient's mouth. So Candice picks up the suction and places it in the patient's mouth. Within 10 minutes there was 500cc (half a liter) of brown blood in the suction canister. 20 minutes later, there was 2 liters!! Surgery was called back.

No, we will not take her to the OR. She has an upper GI bleed, and GI needs to do endoscopy and control the UGIB.

GI...is still in the clinic.

Over the course of the following 12 hours, me and Mikey transfused this lady 20 units of PRBCs, FFP, platelets. We try everything...even the blakmore tube. The daughters are at the bedside watching us work (all damn day) tirelessly. Finally, when the lady's blood was as thin as koolaid, and it was obvious we could not keep up with tht blood loss...they asked us to stop transfusions. Lined along the wall was about 14 liters of blood in suction canisters. Blood all over the bed (nonclotting), blood on the floor.. . GI comes. We've already stopped. It's too late.

Surgery blames GI, they should have come earlier. GI states that it was too much bleeding for them to control...and hat she needed to go to the OR. Surgery states that they needed better localization of the bleeding site. I guess the tagged RBC scan wasn't enough. I guess endoscopy for localization of UGIB isn't something that's done in the OR at King. I guess GI doesn't do emergency endoscopy at King. I guess surgery doesn't operate emergently at King.

All an ER doctor can do is stabilize in a case like this. We cannot operate, or scope. And the hospital's way of doing business is allowing patients to just die in the ER...it's no wonder it's called Killer King.

The worst part......her 2 daughters, one 20 y/o, one 30 y/o, watched their mom bleed out. And no-one would do a damn thing.


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