A patient was admitted to the emergency department after sustaining a gunshot wound to the abdomen. Hemoglobin on admission was 11.4 g/dL and is currently 9.8 g/dL. A transfusion of two units of packed red blood cells has been ordered

Question

A nurse newly employed in the ED says, "I didn't think we gave blood until the hemoglobin is 8 or lower.". How should the nurse manager respond? 1. "You are correct.".
2. "This patient is being given blood because of the possible damage in the abdomen.".
3. "When a patient is sustaining rapid loss of significant amounts of blood, the hemoglobin standard is not honored.".
4. "Because the patient is going to surgery, we must give blood prophylactically.".

Answer 1

3
Rationale 1: This is a special situation in which the standard of 8 g/dL is not followed.
Rationale 2: This is not the best explanation of why this patient is receiving blood.
Rationale 3: This patient has an injury that signifies a potential loss of massive amounts of blood. As the hemoglobin has already dropped to 9.8 g/dL, replacement is indicated.
Rationale 4: This blood is not being given prophylactically but is needed by the patient for a current physiological reason.