Our ED gets its share of close calls. You know....the kind that start as something simple, then snowball into a near catastrophy, until you step in and make sense of the chaos. Later, the mere thought of how the event COULD have turned out, sends shivers up your spine.... and you sense that angels hover especially close to Emergency Depts!!
I'd love to hear about the "squeakers" in your life. Here's the latest in mine:
Early one morning, a man in his forties met the triage nurse at the door, stating calmly that he needed a wheelchair for his wife who was having difficulty breathing.
The wife, also in her forties presented in severe respiratory distress and was obviously worsening by the moment. All essential depts were paged overhead to the ER and soon the place was buzzing with people, all involved in the rescue of this one very calm and stoic woman.
Her husband explained that she had a very rare autoimmune disease, which had significantly narrowed her airway. We got a line established. I gave Solu-Medrol 125 mg IV and Epi 0.3 cc s.c. as the pt endured a Med-Neb of Albutrol and Alupent.
After 10 minutes of with little improvement, the MD decided to give 2 Grams Mag Sulfate IV over 20 minutes, as the RT switched to Rac. Epi. med-neb. Both completed, the once stridorous patient with O2 sat of 78% became suddenly stable and fully able to carry on a normal conversation on just 2 L O2 by nc.
The ENT specialist came in, scoped the pt and told her directly, "You have a trach in your future."
He explained that a sub-glottic stenosis had narrowed her airway to less of a diameter of a drinking straw. "Next time, call 911 and GET HERE immediately, or you'll die!"
Well, with the turnover in ED staffing, the odds of what happened next are pretty slim, but they did. An ambulance call report described this woman to a Tee (for you, Tom!) and I knew exactly what to expect, in fact, I met the woman at the door with Solu-Medrol and epi in hand. The doctor was the same who had been on duty when she came in the first time. I was obviously the same nurse AND the same ENT specialist was on call!
Our ED doctor took one look at the woman and called in the specialist. She was significantly worse this time, with severely laboured respirations and clearly audible stridor. The ENT showed up quickly, setting into motion preparations to use the OR.
All meds given, she experienced very little improvement and was soon whisked off to the OR.
Wow! So glad we had first the "dressed rehearsal"!!! When she returned 2 days later, having become so much worse, the MD would not have had time to identify the problem. None of the rest of that night's crew had worked the first night of her distress, so the fact that I was there, WITH the same MD and specialist.! Amazing. A VERY close call!