Check that at least one large-bore IV is patent and running. If only a small-gauge IV is available, note this for the RRT — they may need to establish additional access.

SpO₂ is 91% on room air. Apply oxygen — start with nasal cannula, escalate to non-rebreather if SpO₂ continues to drop. The RRT RT will manage the airway on arrival.

Lay the patient flat (Trendelenburg if tolerated and no contraindications) to support venous return and blood pressure. Raise legs if able.

Apply direct pressure to the JP drain site where the bleeding is coming from. Control what you can control while waiting for help.

• Ensure Type & Screen is drawn in the correct pink-top tube with proper collection information, or confirm it is already resulted
• Call Blood Bank x6544 to activate MTP
• CRITICAL SAFETY: If no historical blood type on file, an initial AND confirmatory T&S specimen must be collected at DIFFERENT times. Collecting at different times reduces the risk of mislabeled specimens. A mislabeled specimen could result in patient death.

• Notify charge nurse — they coordinate additional staff for the unit
• Charge nurse coordinates OR/ICU readiness as needed
• Charge nurse assigns runner/designee to Blood Bank

Have this ready when the RRT arrives:

• Current medications — especially warfarin (anticoagulant)
• Last INR value — this determines reversal strategy
• Reason for admission and baseline condition
• When symptoms started and how they've progressed
• Last set of normal vitals for comparison

If you need help, call from the doorway or use the call light. Do not leave a hemorrhaging, confused patient alone. If the charge nurse or another RN can come, have them bring supplies or gather information while you stay at the bedside.

• Situation: "58-year-old male, POD 1 lap appy — acute hemorrhage from drain site, hemorrhagic shock, MTP has been initiated"
• Background: "Laparoscopic appendectomy yesterday, was recovering well. No anticoagulants. Last H&H was [value]."
• Assessment: "BP 72/42, HR 150, SpO₂ 88% on NRB, confused, bright red blood from JP drain, rigid abdomen."
• Recommendation: "Needs OR for source control, likely ICU post-op. Surgeon has been notified."

You already initiated MTP based on your clinical assessment (per CC.03.004 — nurse or attending may activate). The RRT takes over management of the resuscitation. The hospitalist places blood product orders and documents activation as required if not already done. The RRT critical care nurse takes over hemodynamic management and product administration.

Your role shifts from primary decision-maker to active support:

• Run labs as ordered: Type & Screen stat, CBC, coagulation studies, INR
• Prepare for additional IV access if needed
• Continue monitoring and documenting vitals per RRT direction
• Charge nurse coordinates OR/ICU readiness and transfer logistics
• Runner/designee may be assigned to Blood Bank

You are not stepping back — you are working WITH the team. You know this patient better than anyone in the room.

This is a post-appendectomy patient with acute hemorrhage from the surgical site. The bleeding source likely requires surgical intervention for source control. The patient will likely need to return to OR.

The RRT and covering provider need to loop in the surgical team immediately.

• The RRT team manages the active transfer to OR
• You may accompany to provide patient history and continuity
• Blood products may continue infusing during transport
• All product documentation transfers with the patient
• MTP remains active — OR/anesthesia continues the resuscitation and the patient likely goes to ICU post-op

After the patient transfers, document:

• Time you first recognized the patient was deteriorating
• Time you activated RRT (x6666 call)
• Time covering provider was notified
• RRT arrival time and team members who responded
• Interventions you performed before and during RRT presence
• Time of MTP activation and by whom
• Products or medications given on your unit
• Time of transfer to OR