Suddenly losing our expert
Rochelle Salmore MSN, RN, NE-BC

January 2012 
Volume 42  Number 1
Pages 50 - 53
  PDF Version Available!

BREAST CANCER. Barely a year has passed since three of the critical care unit (CCU) staff members at our hospital won their battle with the disease. Another nurse and a physician, each from different units, are in the midst of chemo. And now our coworker, JW, tells us she needs a second mammogram. We worry because hospital lore says bad things happen in threes.JW's needle biopsy is positive, as is her lumpectomy and two lymph nodes. She starts chemo, and we coordinate coverage for her during an intermittent leave of absence. We've worked with her for 8 years-she's our friend and mentor...and our expert: the only clinical nurse specialist at our facility certified in wound ostomy and continence nursing.JW completes her third chemo and has a bad reaction. During a blood transfusion, she becomes increasingly short of breath. The second unit is stopped only 10 minutes in. JW is too tired from chemo adverse reactions; she has no reserve left. She requests endotracheal intubation and is transferred to the CCU.The tentative diagnosis? Transfusion-related acute lung injury (TRALI). We scramble to research it, discovering that it's a somewhat rare complication. According to the 2004 consensus definition, "TRALI is a clinical syndrome of acute hypoxemia and bilateral pulmonary infiltrates on chest X-ray occurring within 6 hours of transfusion, in the absence of left atrial hypertension, preexisting acute lung injury (ALI), or other risk factors for ALI."1 Recovery is rapid for the majority of patients (81%), but for the remainder, TRALI is one of the most significant causes of fatalities from blood transfusion.2One week passes. We visit JW in the CCU during the day to talk to her, even though she's sedated. "Hearing is the last sense to diminish," we always say to families. Her retired husband, a volunteer in our wound clinic, sits in the back of the room all day. We spend time with him. Some hospital staff members know JW is sick, but few know she's in CCU. Respecting patient

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