All at once - Feast or Famine

All at Once

        It’s what we call feast or famine in our unit from shift to shift. We came in to our shift examining the labor board to see what our fate was going to be. Today was “feast”, or in other words it was going to be a day that you needed your roller skates to keep up. All but one labor room was filled, triage had a line waiting, there were five scheduled c-sections, and to top it all off there were no beds available on the postpartum units until the afternoon discharges to send our patients out to after they delivered.

        I was in charge this shift and once our team was settled and all reports had been given I went to the safety huddle to get report on all the patients that were on the unit. This is a meeting where all of the charge nurses, doctors, midwives, safety nurses, and anesthesia providers sit down and discuss the patients. We discuss acuity, diagnosis, and potential issues to look out for the day and come up with plans for the day to help things run as smoothly and safely as possible. One of the patients we discussed was a woman who was carrying twins with a percreta of one of the placentas. This is when the vessels of the placenta grow through the uterus and potentially involve other organ systems making it very for a very critical delivery at times. It requires a large team to be prepared for extensive surgery and possibly life threatening outcomes. Another of the c-sections was a gastroschisis case that had come in overnight ruptured and needing to be delivered once the day shift NICU team came on. This is when a baby is born with a portion of their bowel on the outside of their body and requires surgical intervention.  So after review of all the patients we knew not only would we have a busy day but that we had two very involved cases to top it off.

        The day ran very smoothly for the most part for the first portion. They began calling for deliveries one after another but they were spaced out in a way that they were manageable and we were able to attend each one and keep the day rolling without complication. I got a call that the gastroschisis patient was rolling back to OR1 and I called the NICU team to make them aware so they could gather their team. The case began and all was well. After about fifteen minutes I heard a call for a physician to come to triage eleven STAT. I glanced at the board and saw that this was the patient with the percreta we had discussed in huddle earlier that day. She apparently began bleeding and one of the babies was having a heart rate deceleration. Not even two minutes later another call came over for a STAT c-section to OR 3. We had set the room up for twins earlier in the day. I called the NICU charge and transport nurse immediately to update them. This was going to require three large teams for the NICU to be in deliveries all at once which was a lot. I ran back to the OR even though it wasn’t my turn for a delivery to lend a hand and assist in any way I could. The case began and they got the first baby out immediately. The NICU team went to work caring for the infant. Another call came over for delivery in room eight. It was my turn and I responded that I was on my way.