After receiving report and assessing her patient, Maria knew immediately that there was something wrong with her patient. She had taken care of him the night before and noticed that his mentation was off, JP output was increasing, and he had a large bulge to his abdomen that looked like a hematoma. She called the MD multiple times to get an order for a CT scan. She received all orders except a CT scan. An hour, 2 hours, 3 hours later she continued to closely monitor her patient and tried numerous times to get the CT scan. She went through the appropriate chain of commands (charge, MD, RN, RRT). Finally, when there was a noticeable change and the hematoma was moving up towards the patient's diaphragm, the MD gave the order to transfer the patient to the ICU and immediate emergency surgery was needed that night. The patient's hemoglobin was 5.2 on transfer to the ICU with lactic of 4.0. Maria was outstanding that night and never gave up when the MD wouldn't listen to her concerns. I would be proud and know that I am being well taken care of if she was my nurse.