SOLVED44

Carol had butterflies in her stomach as she checked her appearance in the mirror hanging in the staff lounge. Her long hair was neatly pulled up in a ponytail and her nurses’ scrubs were clean and pressed. She exited the staff lounge and entered the hustle and bustle of County Hospital’s ER to begin her first shift as an RN. The first few hours of her shift passed slowly as Carol mostly checked vital signs and listened to patients complain about various aches, pains, coughs, and sniffles. She realized that the attending physician, Dr. Greene, wanted to start her out slowly, so she could get accustomed to working in the busy ER. Carol knew, though, that the paramedics could bring in a trauma patient at any time. After her lunch break, Carol didn’t have to wait long for her first trauma patient. The paramedics burst in through the swinging double-doors of the ambulance bay wheeling in a young man on a gurney. Edward, a veteran EMT, recited the vital signs to Carol and Dr. Greene as they helped push the gurney into the trauma room, “18-year-old male, GSW to the right abdomen, heart rate 92, respiratory rate 22, blood pressure 95/65, no loss of consciousness.” Carol’s breath caught in her throat a bit. She knew that gunshot wounds were sometimes the most difficult traumas to handle and it was her first one! Once inside the trauma room, Dr. Greene began his initial assessment of the patient, while Carol busied herself with the things she knew would be needed. She attached a pulse-ox monitor to the patient’s index finger so Dr. Greene could keep an eye on the O2 levels in the patient’s blood, and she inserted a Foley catheter so the patient’s urine output could be monitored. After finishing her initial duties, Carol heard Dr. Greene saying, “It looks like the bullet missed the liver and kidney, but it may have severed an artery. That’s probably why his BP is a bit low. Carol, grab a liter of saline and start a fast IV drip … we need to increase his blood volume.” Carol grabbed one of the fluid-filled bags from the nearby shelf, attached a 12-gauge IV needle to the plastic tubing, and gently slipped the needle into the patient’s antecubital vein. She then hung the plastic bag on the IV stand and let the fluid quickly start to flow down the tubing and into the patient’s vein. The reaction was quick and violent. The patient’s heart rate began to skyrocket, and Carol heard Dr. Greene shouting, “His O2 saturation is falling! Pulse is quickening! What is going on with this guy?!” Carol stood, frozen in place by the fear that had wrapped itself around her throat. She heard Dr. Greene continuing, “Flatline! We’ve lost a pulse … Carol, get the crash cart, we need to shock this guy to get his heart going again!” Carol broke free from her momentary trance and did as Dr. Greene had ordered. She then started CPR as Dr. Greene readied the cardiac defibrillator to shock the patient. They continued to alternate between CPR and defibrillation for almost an hour, but to no avail. As Dr. Greene announced the time of death, Carol felt her eyes begin to well with tears and her lip begin to quiver. She couldn’t believe that she had lost her first trauma patient! Her sadness turned to fear though as she noticed that the fluid in the Foley catheter bag was bright red. “Dr. Greene, there’s hemoglobin in the Foley bag,” she said. “How could that be?” responded Dr. Greene. Carol began to trace back over her steps in the trauma, trying to think of anything that could have caused the hemoglobinuria. Her fear turned to outright terror as she looked at the now empty bag on the IV stand. Its label didn’t read “Saline,” but rather “Distilled Water.” She looked at Dr. Greene, her heart quickly sinking, and said, “I think I may have killed the patient.”
SCIENCE
HEALTH SCIENCE
NURSING

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