Telephone Triage

One weekend, the scrub tech answered the phone and got this panicked look on her face. She had wide eyes with a look of panic and said to whoever was on the phone "You need to come in but I'm going to have you talk to a nurse". It was a grandmother to be and she said "My daughter is pregnant, (went through a whole health history), her water broke and the umbilical cord is hanging out. Do we need to come into the hospital?" Now this is not unheard of, it rarely happens, but I can remember someone who had come in because she had something hanging out of her vagina, and it was indeed the cord, and thankfully it hadn't been compressed too much....I think because the baby was transverse or breech, but baby was delivered and fine. But it is a true emergency. After a few quick questions, it was determined that it sounded like a cord, and since you can't assess over the phone what is going on, and because of the potential serious nature of a cord prolapse, she was told "Yes, you need to have her get into a knee-chest position, hang up and call 911". Thankfully, anesthesia was already in house, we had an OB doc there who had just finished a delivery who had overheard the phone call, OR was opened and we were all ready. We figured she'd already have a IV in from the ambulance ride, doc would do a quick sono to make sure we had a reason to deliver urgently and we'd were ready. So a bit later, she rolls in, smiling, sitting up on the cart and we quickly check to see if we in fact have a prolapsed cord. The patient states "Oh, I pulled it out". Everyone is dumbfounded, and she holds up an emesis basin....with her mucus plug in it.

Everyone breathed a sigh of relief, the tension lifted like a heavy blanket. There was never any doubt that we made the right decision to tell her to come in. We aren't allowed to give out info over the phone, all we can say is call your doc or come in, because you can't assess over the phone. This is a perfect example.