Ashley is a 17year old female who attended the rural accident and emergency department complaining of abdominal pain with her partner. Ashley was initially triaged by the registered nurse (RN), she had her vital signs and a pain score completed. Ashley’s vital signs appeared to be within normal limits and her pain score was three. Additionally, she had a urine sample tested by the RN and this was normal. Hence, it was considered by the RN that Ashley could sit in the waiting room. It was a busy night in the rural emergency centre as there had been a multiple road traffic accident involving a truck, car and a motor cyclist. Hence, Ashley was kept waiting. Ashley was informed by the nurse of this traffic accident and that there may be a delay in treatment. Ashley also noticed that there appeared to be a shortage of staff. Consequently when Ashley finally went through to the emergency department four hours after her initial presentation. However, she was seen and examined by the Doctor. Unfortunately, the cause of Ashley’s abdominal pain at this point was unknown as, the doctor was unable to complete his examination. Prior to the completion of his examination the doctor was called to attend one of the patients who had been in the road traffic accident who was deteriorating. Subsequently, Ashley was ordered and given Pethidine for pain relief as per the medication chart by the nurse. Ashley also had an intravenous line inserted and a full blood count taken by the nurse as per the doctor’s instructions. Ashley’s vital signs were continued by the nurse via the monitor. Ashley’s abdominal pain then appeared to settle and she drifted off to sleep. Two hours later Ashley awakened as, she had started to bleed vaginally and complained of further abdominal pain. Ashley’s partner was concerned and notified the nurse. The nurse notified the doctor of the blood loss and Ashley’s vital signs, she was instructed to collect further blood samples for a HB, group and hold. At this time Anna stated that she was a Jehovah’s Witness and did not want any blood products. She also confided in the nurse that she could be pregnant as, she has not had her usual menstrual periods but a scanty blood loss for the past three months. Ashley did not want the nurse to notify her parents of her condition or her possible pregnancy. However, the nurse shared this information with the doctor and the doctor ordered an urgent abdominal scan to determine if she was pregnant. Scan findings indicated that Ashley was about 14 weeks pregnant. However, no fetal heart beat was determined. Ashley subsequently bled very heavily and was taken to theatre following consent for an evacuation of the remaining uterine products. During the operation Ashley lost a significant amount of blood and the doctor ordered a blood transfusion to save her life. In theatre, nursing staff assisted the doctor to complete the blood transfusion. Following the procedure Ashley was transferred to recovery area. In recovery Ashley was angry and aggressive towards the nurse when she discovered that she had a blood transfusion in progress.
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