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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