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Archive for December, 2009

Crash C-Section on Dead Mom with Miraculous Result

Posted by realityrounds on December 29, 2009

Happy endings are certainly needed now-a-days, and this story has one.  As reported by ABC news, Tracey Hermanstorfer of Colorado went into a complete cardiac arrest (no pulse, no blood pressure, cyanotic) during labor with her third child.  It is being reported that Tracey was being prepped for a “catheter”  (epidural, my guess), when she became unresponsive  and in complete arrest.  Her doctor performed an emergency C-Section right in the room (no anesthesia, pour betadine over the abdomen, and cut) and placed the lifeless infant in the father’s hands.  Within seconds of delivery, mom’s vital signs came back, and the baby started to show signs of life right in his dad’s hands.   Tracey’s doctors state they have no idea why she went into a complete arrest, and are even more stunned that she recovered.  This is truly an amazing story…….and of course…..I have many questions.

I have unfortunately been in Crash C-sections on “dead” moms before.  Most often, we have a reason for the code right away.    One mom was a severe alcoholic.  She was crashed, and during the section her liver essentially disintegrated due to cirrhosis.  She eventually died in the ICU, and her baby died of Fetal Alcohol Syndrome in the NICU.  Another mom presented in the ER in full arrest.  She was slashed right in the ER.  unfortunately both her and her baby died.  Turns out she had a severe cardiomyopathy.  Another mom had a very normal labor, just like Tracey’s, and crashed out of the blue.  She was progressing normally.  It was her third child and all was going well.  All of a sudden she crashed.   She was rushed to the OR and both her and her baby were fine.  The tentative diagnosis:  amniotic fluid embolism.  A rare condition, and an even rarer condition to survive.

We may never know why Tracey coded during labor.  Some differential diagnosis that I can think of are a highly placed epidural (this can cause respiratory depression and paralysis), and amniotic fluid embolis (very rare, and even rarer to survive), a pulmonary embolism, and undiagnosed congenital heart defect.

Another issue that makes me pause is the fact that they placed the depressed neonate in the father’s hands.  Why they did not immediately begin neonatal resuscitation on this infant under a radiant warmer is beyond me.

So, what are your theories on what happened to this mom?

RR

Posted in health | Tagged: , , , , , | 33 Comments »

Nuthin’ Says “Happy Holidays!” Like a Code Green

Posted by realityrounds on December 23, 2009

All the health care worker elves are so busy at the station,

Cuz from December to Jan-u-ary, you can’t take no vacation.

So we work and we work, and keep the bitchin’ to ourselves,

Cuz’ holidays don’t exist for the health care worker elves.

**********

In the rooms we intervene and we assess and we admit

and at the station the angry elf , he don’t care, don’t give a shit.

He is so very mad, he is so very entitled.

He want what he want, and he don’t care bout what is vital.

**********

Us health care workers elves, we stay calm, we say “don’t be mean.”

But the angry elf just escalates, we must call a mean “Code Green!”

**********

“Code Green!  Code Green”!  A color we do not want to hear.

A color festive for the holidays

But in the big house brings only fear.

**********

And Santa’s security helpers ,they all come a runnin’

They tell the mean ole’ elf to take  his story walkin’.

**********

So the health care worker elves

Watch the activity in silent night

We shake our heads in saddness

We know there is no light.

**********

Will mean ole’ elf who threatened us

Get the help he does not want?

Will next Christmas bring him

The souls he still does haunt?

**********

Us health care elves will think the best

Of peace for all, not one.

God bless us health care elves,

God bless us everyone.

*Code Green:  A violent person.
RR

Posted in nursing | Tagged: , , , , | 8 Comments »

Empowered Patient or Entitled Patient?

Posted by realityrounds on December 17, 2009

In my past life I was a journalism major, and I know about the power of an article’s title to suck a reader in, and maybe, sway their judgment about a subject before they ever read the article.  Case in point:  CNN just ran an interesting article in their “Empowered Patient” section.  The article addresses the case of Joy Szabo who had one previous C-Section and would like to have a VBAC for her fourth child.  Her obstetrician informed her that she would not be able to have a VBAC due to hospital policy and liability concerns.  So, Joy packed up and moved to Phoenix Arizona three weeks before her due date to have a VBAC, which she did very successfully.  Yeah Joy! You are a fellow VBAC sister.

The title of the CNN article is this:  Mom fights, gets the delivery she wants. Does anyone else see anything wrong with this title?  To me, it sways the reader, especially the lay reader, to believe the mom is being selfish and entitled to get something (a delivery) that she “wants.”  What if the title was this:  Mom fights, and avoids getting sliced open against her will. Do you think readers, especially lay readers, would view the article in a different way?  I wonder.

Obviously it is not just a title that will sway a readers opinion.  Personal experience means all and everything to a  single person.  If someone had a tragic VBAC experience, that is all that matters and all that anyone needs to know.   This is proven over and over again in the comment thread to the CNN story.   Anecdotal stories can be very heart wrenching and moving, but public health policy certainly should not be swayed by anecdotes alone.

If you dare, read the over 450 (and climbing) comments included in this thread.  I refuse to get sucked in to comment, especially when the comments are filled with people who do not know what the hell they are talking about.  (I have also been reading an article about Michelle Duggar who just delivered a 25 weeker, on People magazine’s website.  The comment section on that thread is also filled with dunder heads who do not know what the they are talking about, like mom blaming.  But anyway, that is for another post. ).  It can be frustrating reading what some in the general public believe about women, and women’s and infant health care.

From this article in a very main stream media outlet, it seems from many of the comments that Ms. Szabo acted more like an entitled patient and not an empowered one.

Thoughts?

RR

Posted in health | Tagged: , , , , | 29 Comments »

Sunday Funnies: A Birth Blogger Rap

Posted by realityrounds on December 6, 2009

A little history.  This weekend Jill from The Unnecesarean, posted a very well thought out piece on race issues and childbirth.  To some of her readers’ chagrin, another well-known birth blogger who has very different views on childbirth, chimed in.  Dr.Amy from the Skeptical OB blog added many, many comments to Jill’s post which left a lot of Jill’s readers furious.  Because I work in a hospital, I can actually agree and sympathize with a lot of Dr. Amy’s points.  But there is also so much cynicism and lack of compassion in her points that it makes me suspicious that she is deliberately trying to push buttons for attention. (I could be wrong though).    The comments on the thread was a debate about childbirth choice, racism, class warfare, natural childbirth, modern obstetrics and many more issues.  If you want to go down that rabbit hole of comments, check out Jill’s site (linked above).

I of course, being the class act that I am, stayed above the fray (actually, I am a NICU nurse and do not have enough OB knowledge to even leave a good comment).  The blog war did inspire me, the class act that I am, to write a rap song inspired by this Dr. Amy thread.  It is not so much a song about Dr. Amy’s actual birth practices, but the general distortion and demeaning of “alternative” methods of birth, and Dr. Amy’s presence in the blogosphere.

Please sing in the tune of Kanye West’s “Gold digger”. (Because who else would you think of when debating American childbirth than Kanye West?…..God, I need help.)

**********

She take my web hits when she in need

Yeah she’s a trifling “friend” indeed

Oh she’s a blog digger, way over town

That dig’s on me

**********

Doctor the bomb

Met her at the website Salon

With perinatal statistics under her underarm

She always right

Yeah she never be wrong

And if you ready to push,

She’ll say you’re closed, thick and long.

**********

Now I aint saying she a blog digger

But she aint messin’ with  low traffik-ers

Now I aint saying she a blog digger

But she aint messin’ with  low traffik-ers

**********

21 years, 21 years

Plaintiff attorney got docs for 21 years

You say you wanna push and not be pushed to the O-R

But  lawyers on docs backs want to make themselves richer, and docs poor-er

**********

Now I aint saying she a blog digger

But she aint messin’ with  low traffik-ers

Now I aint saying she a blog digger

But she aint messin’ with  low traffik-ers

**********

Now you had one C-Section and feel under attack

Cause you want a normal birth, yeah you want a nice VBAC

But she will scare you to death, and you will not get to far

And you will leave her institution with a second  uterine scar.

**********

Now I aint sayin’ she a blog digger to get someone mad

She got a website to promote, have you seen all her blog ads?

She wants babies to be safe and women to be healthy

But to generate traffic you must be controversial and stealthy

**********

So let’s stick by her side, yeah that’s what I said , yeah that’s right

You can get your word out, yeah you can put up a fight

Cuz’ when she done slammin NCB and homebirth no further,

She’ll leave all our asses to hi-jack an unassisted childbirther.

**********

Now I aint saying she a blog digger

But she aint messin’ with  low traffik-ers

Now I aint saying she a blog digger

But she aint messin’ with  low traffik-ers


*I should probably just stick to my day job.*

RR

Posted in health | Tagged: , , , , , , | 22 Comments »

Is a Hospitalized OB Patient Sick Until Proven Healthy, or Healthy Until Proven Sick?

Posted by realityrounds on December 5, 2009

Posted in child birth | Tagged: , , , , , | 20 Comments »