Losing a patient in the OR

[DrBeaker]

I remember recently a thread where you guys were talking about losing a patient in the OR. Most had not, at least not in a long time.

7 months into CA-1, lost a guy last night. MVC, high rate of speed, thrown from vehicle. Level I trauma alert called. Intubated in field by EMS, pupils fixed and dilated B/L. Positive FAST in trauma bay, became unstable so we went up to the OR, massive transfusion protocol activated. Blood, cell saver, FFP given. First gas in ER pt had a pH of 6.88. Managed to keep him going until we were ready to transfer to the bed and go to ICU, became really brady, lost pulses, started CPR. Got him back but eventually went into PEA, 2 more cycles of CPR, vaso/epi, called it.

Losing battle from the beginning, still stinks

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[chocomorsel]

Sucks especially when they are young. But traumas can be that way.

Lost one my first day as a CA2. Middle aged guy for a hemipelvectomy. Not sure what happened, hypovolemia from lots of blood loss, pulmonary embolus (pt was tberged and they were working on the pelvis in very poor anatomy from frequent infections - paraplegic), gave him 3 units of PRBC's and his K came back >7, so it was a number of things together. The thing is this guy was fine before, talking to me, an elective procedure for frequent sacral infections and I gave him the schpiel of anesthetic risks etc to include death, blah, blah, blah. Well in this one, that's exactly what happened. Family refused an autopsy so we shall never know for sure the cause.
That was hard. The crappy thing is after the first round of shock/CPR/drugs we brought him back and the orthopedics went back to work on him. Don't know if they were at a place they couldn't stop but they were eager to finish what they started. I wanted to tell them to give it a rest, pack it in and maybe come back later, but my attdg and all the other 3/4 extra attendings didn't speak up and therefore I didn't. Finally a general surgeon came back in after we coded him two or three more times and put an end to the madness. Wow.

 

[pgg]

I remember recently a thread where you guys were talking about losing a patient in the OR. Most had not, at least not in a long time.

I think most of us were answering in that thread in the context of "unexpected" deaths, hence the low numbers. Anyone who does any nontrivial amount of real trauma will lose patients just like yours.

Losing battle from the beginning, still stinks

It does.

 

[Noyac]

OR loses come from time to time. It depends on your practice location and acuity mostly but nobody is immune. People can say that the ones expected to not survive before they enter the OR don't hurt as much or that they may be easier to accept but all I can tell you is, you never really know how each one may affect you. All I can say is be prepared, know your support system, and find "your" way to deal with it. Some like to talk about it, others prefer not to talk. And by all means, be the best doctor you can be for the sake of your pts.