Anatomy of a crash

A friend at work Facebooked that they saved a life today. I'll find out more details when I get back to work this week, but it made me consider that part of my job--one folks may not nomrally associate with being a labor and delivery nurse. The job is often coaching, giving pain medication and teaching. It is reassurance, explanation, hand holding, leg holding and breathing. And sometimes it is panic, and running and praying.

A crash is a name used by nurses ( and others) to denote the emergent c-section of a patient. They happen at any stage of pregnancy after 24 weeks. In my experience, they are the reaction to the sudden and unresolving (lasting several minutes) decrease in fetal heart rate, below 100 (often much lower) that do not repond to position change, oxygen administration or IV fluids. I have been a part of two that were the result of a maternal seizure and one from a respiratory arrest of the mother. They happen in the delivery rooms when a patient is in labor and in the triage area where a patient might just come in for some vague pain. I have cut the clothes off of one patient to get an IV in. They involve a massive influx of staff into a patient room, each doing a single task--starting an IV, disconnecting plugs, putting in a foley catheter, explaining to family and patient and pulling the patient in there bed to the OR--all in less than a minute. The flurry extends to the nurses station where staff are tring to reach the attending, respiratory therapist, and most of all, anesthesia. In a true crash, the patient is put to sleep and intubated. There is no incision until the anesthesiologist says "Cut". The usual symphony of movement in surgery is replaced by a hastily splashed antimicrobial wash over the abdoemn, two disposable scalpals thrown on the field, a surgeon (usually the resident) and a tech helping as first assist. Cut, tear, cut, tear, cut, tear. One hand cuts, four hands pull tissue apart. Minutes count. Seconds count. The fastest crash was skin to baby out in a minute. The baby cries and someone in the room says "Okay folks, we can slow down." And the entire room (except the infant resuscitation team) releases its pent up breath. The rest of the crew dons hair covers and masks--items usually left in the hurry. The nurse and tech do a count--though an x-ray will be taken at the end to make sure nothing is left in the patient. The stitching begins and the circulating nurse goes to band the father of the baby and tell him about mom and baby. The pace comes down to normal.The staff will relive it through the night and it will be discussed as one of many "war stories" on slow nights at the nurses station.

I often wonder what patients think of this, if there is lasting trauma--like post traumatic stress. It is not the delivery women envision. It is so very fast. It helps if the baby is stabile enough for mom to see in recovery--then it's real. She's a mom. Her baby is safe.