Work is Hazardous to My Health
A brief story of brief stupidity. The moment when I realized that a small mistake was actually a big mistake and that, that big mistake might ultimately lead to my death. How a little pill saved my life, and how a medic student was really the culprit behind said small mistake that was really a big mistake.I almost died today. A man comes into my busy level 1 trauma center with ALOC and no known cause. The sister says he has had a fever for the last couple of days and developed hives yesterday. The paramedics think he probably overdosed on benadryl and is just sleeping it off. If only that had been true. When we realize this man isn't getting any better, becoming more somnolent and suddenly tachy, the benadryl OD dream comes crashing head first into the meningitis reality. A head CT is ordered, and a lumbar puncture set up is at the bedside, now the real fun begins.
I need to back up a second and explain, at this moment I had a medic student following me around, this is important because I am using it as my excuse for the stupid thing I do next. As we are setting up for the LP I work to move my patient into a proper sitting position. His sister is assisting me and we lift the guy up and hold him in place. While this is all going on I am directing the medic student where to stand, getting masks for everyone and bracing myself to help hold this rather large man in a pretty awkward position, especially considering he wasn't exactly with it enough to help us out. So now the man is leaning against me and his sister, and it's taking all our strength to hold him there stable enough for the LP. Suddenly a little fleeting thought races through my brain... I need a mask... In my haste to make sure everything else is done and all other members of our little party are taken care of and I completely forget to grab a mask for myself. Now you would think that I could simply have said to the medic student, who is just there to observe, "hey grab me a mask would ya?". Yeah, really wish I had done that. But, you see, that little fleeting thought had moved so fast that by the time I realized it was there, ZOOM, away it went. So now I'm standing there in very close proximity to a probable meningitis patient without a mask while the doctor is attempting an LP. Folks, not my finest hour. And once I see how cloudy and off colored the CSF is, I know deep down in my gut, the one that drops when you know you've done a stupid thing, that it's bacterial.
LP is done, CSF fluid is sent down, and now I wait, hoping that my instinct is wrong and that actually he has viral meningitis.
I really hate it when I'm right.
Results come back with raging bacterial meningitis, and my mind is racing to remember all the details of every second I spent in that room. How close did I actually get, did he ever cough on me, how many "large" droplets did I dodge, how many scored a direct hit on my lungs, how large is large anyway, do I need medication, how effective is medication, what if I actually get meningitis, 1 in 4 people DIE, wait... really? 1 in 4? YES!
Finally I take a deep breath, step back and pause. Once I'm calmed down I make a beeline for my charge nurse to inform her of what happened, beg for prophylactic antibiotics and promise her I will never forget to wear a mask again.
A few hours later I am standing at the pharmacy getting the little pill that saved my life. One lonely little Cipro 500 mg that kept me from a fate worse then death. With one big gulp of water I swallow it down and breathe a sigh of relief. I'm safe, no meningitis, I'll be ok.
As the adrenaline starts to dissipate and my mind clears, it hits me, I ALMOST DIED TODAY! I almost died, and a little pill saved my life. Now, we all agree this is really the medic students fault, because obviously they distracted me. But despite this I am alive and well and meningitis free and quickly coming to the realization that my job might actually be hazardous to my health.Last edit by Joe V on Mar 17, '13
MunkiRN has '2+' year(s) of experience and specializes in 'ER, ICU'. From 'Mesa, AZ, US'; Joined Jul '09; Posts: 57; Likes: 76.10Mar 17, '13 by metal_m0nkI wouldn't necessarily blame the medic student for distracting you...
But he/she should have been quick to supply you with a mask if he/she were actually paying any attention to what the hell was going on. How could it not have dawned on him/her that the person who handed him/her a mask was maskless for the procedure??!0Mar 17, '13 by Armygirl7Eeeeew what a bummer. I hate that rush feeling of fear when you realize you forgot something so important.
As soon as an LP is ordered in our ER that Pt is on droplet isolation and it is my (or any RNs) responsibility to post the signs and lay out the masks etc outside the room. Also it sounds like you were describing a seated posture for the LP. I've only ever seen LPs done with the Pt lying on their side, knees tucked up toward the belly.
I am actually amazed at how little I get sick considering all that passes under my nose in the ER. I guess my raw red hands are worth it!5Mar 17, '13 by kczarI certainly hope you're being funny blaming the medic student for "distracting" you. YOU went into the room without a mask. Did the medic student tear the mask off your face? You had an exposure, you're going to have more of them unless YOU take better precautions.30Mar 17, '13 by MunkiRNDISCLAIMER: No Medic Students were harmed in the writing of this article. All perceptions of such are your own creation and not that of the author.
Thank you for all the positive feedback, it's great to have the support for my first article!