Jo is a 46 year old female who attended the rural accident and emergency department complaining of upper abdominal pain with her partner. Jo was initially triaged by the registered nurse (RN), she had her vital signs and a pain score completed. Jo’s vital signs were recorded her temperature was 37.2, pulse 96, respirations 16, BP 136/86 and her pain score was six. Jo also complained of nausea and abdominal bloating. Jo told the nurse that she had been taking Mylanta for the past year for indigestion. Additionally she had a urine sample tested by the RN and this had no abnormalities. Hence, it was considered by the RN that Jo should be seen immediately for assessment by the doctor. It was a busy night in the rural emergency centre as, there had been a motor cycle road traffic accident. The driver of the motor cycle had obtained significant leg and chest injuries. Hence, Jo was kept waiting. Jo was also aware of this accident and did not want to bother anyone as, they appeared to be very busy as, well as being short of staff.
Despite the department being busy the RN did manage to intermittently assess Jo. However, Jo was getting increasing nausea due to her pain levels. Jo vomited dark coffee ground fluid two hours after her admission to the Ed department. The RN checked Jo’s observations and her pulse was rising and her BP falling and notified the doctor of Jo’s condition. The doctor then got a more senior doctor to assess Jo. Jo also had an intravenous line inserted by the Dr, a full blood count and group and hold. Jo was prescribed Pethidine 100mg and Maxolon 10mg by the Dr for her pain and nausea. This pain relief made Jo drowsy and she vomited coffee ground fluid again. Jo’s vital signs were continued by the nurse via the monitor. Jo was prepared for theatre following consent for an emergency endoscopy. Within theatre the anaesthetist encountered difficulty maintaining Jo’s saturations in theatre during the endoscopy procedure. Jo was transferred post endoscopy to the high dependency unit within a regional facility. The anaesthetist perceived that Jo had aspirated whilst vomiting in the ward prior to the procedure.
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