SBAR #1

Situation - basically healthy 50-ish year old in for a total abdominal hysterectomy for a fast growing fibroid uterus. She is very thin, the fibroids are so large you can see her uterus pushing against her abdominal wall up above her umbilicus and to the left side.
Background - she has waited almost 5 years and suffered with heavy bleeding before coming to seek medical care.
Assessment - starts out as a relatively routine hysterectomy, turns into a life threatening event requiring 6 units of packed red cells, 2 units of fresh frozen plasma and leaving the OR intubated and directly admitted to the CCU.
Recommendation - calling for help early.

True story.

I was overwhelmed at times, but I got through with the support and help of my colleagues. Just as I was feeling the need to get help, help arrived.
BC, the nurse anesthetist (CRNA) asked me to call the blood bank to order blood. The surgeons asked what the blood loss was. There was only 300 cc in the suction canister, but I pointed out that the sponges were saturated, the surgical drapes were saturated and I could see that the linen under the patient was getting saturated. The surgeons agreed to order blood.
At one point there were 3 anesthesiologists and CRNAs, 2 anesthesia techs, 2 surgeons, 1 PA, 2 surgical techs, a helper RN and myself in the room dancing through our tasks. I couldn't keep track of all of the conversations.
Until Beth showed up, I was slowly losing ground in keeping up with all of the requests. I had been reaching for the phone to call for help when she showed up. At first I thought she coming to give me a break, I started shaking my head, meaning that this was not a good time. She then asked if I needed help. I wanted to hug her! We started working together to provide supplies, get equipment and chart all of the interventions being done. It truly was a dance.

The surgeons eventually finished their tasks. They slowed the bleeding, applied various hemostatic agents and closed the incision. BC and his attending tested the patient to see if she could be extubated, and determined that was not going to happen.
Getting the correct bed so the patient would go straight to CCU was a mix up since BC and his attending at first wanted to go to recovery then CCU.
I had Thursday off, to go to classes, and when I returned to work Friday I heard about my patient: she had returned to the OR twice to look for further bleeding. During the second time they didn't find much to concern them - the bleeding had slowed or stopped, finally.
I met up with BC at one time during the day and he thanked me for my assistance during the case and updated me further on her progress. She is doing better, may be extubated today or sometime during the weekend.


One frustration of my job is that we rarely hear about our patient's after they leave our care. HIPAA has made it so that looking at their records is not acceptable. Knowing that someone who is so critically ill is getting better is an amazing thing, especially if you took part in their care during such a critical time. I am grateful that my colleagues at work are so generous with their thanks and information. We aren't violating the patient's rights in a way that endangers their dignity or privacy. We cared for them, we care for them still, we are interested in their continued well being or outcomes.