DELIVERY IN THE EMERGENCY DEPARTMENT
James Buchanan , MD
It was near the end of a pretty typical shift at Jewish Downtown . For those of you who haven ’ t been there or don ’ t know , there is zero OB coverage at Jewish . I was finishing my charts when I heard the secretary say “ pregnant woman in labor ” over the phone . That is a pretty unusual thing to hear at Jewish so I immediately asked the attending who was sitting closer if I heard that correctly . I also half-jokingly said I definitely wanted in on the patient if they were serious , because I still needed a few more deliveries . The attending chuckled and replied that she thought the secretary was only joking because there shouldn ’ t be any reason for a laboring patient to come to Jewish , so I returned to my charts .
About two minutes later they call for a physician from the room behind the doctors ’ area and we walk into what is in fact a laboring patient . The nurses state she seems to be contracting every three to four minutes , but they don ’ t know much else at this point . While the attending checks her cervix , I grab the ultrasound and check the fetal position . She was about 8cm dilated and the best I could tell the baby was vertex but the head was so far down I gather this from the rest of the anatomy . Immediately calls start going out to the neonatologist at Kosair while we attempt to talk to the family and figure out how the patient ended up at Jewish . Here comes our first problem : neither the patient nor the family speak a word of English . Not only that , but there is no translator phone in the room , so the family has to be taken to another room to try to get some questions answered .
In the meantime , I attempt to get a fetal heart rate to assess how the fetus is doing .
Problem 2 : The only doppler is a pen style for checking pulses that doesn ’ t actually display a pulse number .
I go back to the ultrasound , find the heart and count the beats on the screen while a nurse counts for 15 seconds to get a FHR of about 144 , which is always reassuring . In the meantime , we are able to obtain some more information from the family .
Apparently , the patient ’ s water broke during her office visit around 2 pm ( it ’ s now almost 11 pm ) and she was told to go to the hospital . For whatever reason , they decided to wait and they got mixed up between Norton and Jewish , hence our current situation . We are calling Norton ’ s L & D informing them of the situation , and transport
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