In Habersham County, Tom was feeling slightly nervous as heexited the staff lounge
and entered the hustle and bustle of County Hospital’s ER tobegin his first shift as an RN. The first few hours of his shiftpassed slowly as Tom mostly checked vital signs and listened topatients complain about various aches, pains, coughs, and sniffles.He realized that the attending physician, Dr. Greene, who wasrather “old school†in general about how he interacted with nursingstaff , wanted to start him out slowly. Tom knew, though, that theparamedics could bring in a trauma patient at any time.
After his lunch break, Tom didn’t have long to wait before theparamedics burst in through the swinging double-doors of theambulance bay wheeling in a young man on a gurney. Edward, aveteran EMT, recited the vital signs to Tom and Dr. Greene as theyhelped push the gurney into the trauma room, “A 18-year-old male,GSW to the right abdomen, heart rate 92, respiratory rate 22, bloodpressure 95/65 no loss of consciousness.†A gunshot wound! Tom knewthat gunshot wounds were sometimes the most difficult traumas tohandle.
Once inside the trauma room, Dr. Greene began his initialassessment of the patient while Tom got busy organizing the thingshe knew would be needed. He attached a pulse-ox monitor to thepatient’s index finger so Dr. Greene could keep an eye on the O2levels in the patient’s blood and he inserted a Foley catheter sothe patient’s urine output could be monitored.
After finishing his initial duties, Tom heard Dr. Greene saying,“It looks like the bullet missed the liver and kidney, but it mayhave severed an artery. That’s probably why his BP is a bit low.Tom, grab a liter of saline and start a fast IV drip … we need toincrease his blood volume.†Tom grabbed one of the fluid-filledbags from the nearby shelf, attached a 12-gauge IV needle to theplastic tubing, and gently slipped the needle into
the patient’s antecubital vein. He then hung the plastic bag onthe IV stand and let the fluid quickly start to flow down thetubing and into the patient’s vein.
The reaction was quick and violent. The patient’s heart ratebegan to skyrocket and Tom heard Dr. Greene shouting, “His O2saturation is falling! Pulse is quickening! What is going on withthis guy?!†Tom stood frozen in place by the fear. He heard Dr.Greene continuing, “Flatline! We’ve lost a pulse … Tom, get thecrash cart, we need to shock this guy to get his heart goingagain!†Tom broke free from his initial shock and did as Dr. Greenehad ordered. He then started CPR as Dr. Greene readied the cardiacdefibrillator to shock the patient. They continued to alternatebetween CPR and defibrillation for almost an hour, but to no avail.As Dr. Greene announced the time of death, Tom felt a sickeningfeeling in the pit of his stomach. He couldn’t believe that he hadlost his first trauma patient!
Then Tom noticed that the fluid in the Foley catheter bag wasbright red. “Dr. Greene, there’s hemoglobin in the Foley bag,†hesaid. “How could that be?†responded Dr.
Questions
1)     After Tom made his error, isthere anything that could have been done to save the patient’slife?
2) The solute concentration in blood is equivalent to 0.9%NaCl.
Several drops of blood were added to three different solutions:0.09% NaCl, 0.9% NaCl and 9% NaCl. What would happen to the cellsdipped in three different solutions?
