Close Calls !!

  1. 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!
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    About AngelGirl

    Joined: Feb '03; Posts: 110; Likes: 8
    RN in E.R.


  3. by   ERNurse752
    I wasn't in the ER for this one, but I'll share the story.

    The other evening, a 56 y/o male comes to ER (driven per POV by his wife) with intermittment CP since the day before. No other s/s.

    So the nurse takes him back to a monitor room, he takes off his shirt, and not 30 seconds after being placed on the monitor, goes into v-fib...

    Shocked x 3, wakes up fighting, "What the f*** was THAT!"

    They're getting all the standard MI drugs going (tombstones in inferior leads), his wife comes back to the room...and he does it again.

    Shocked x 2, comes back.

    Happens again...shocked x 2, comes back.

    Cath lab arrives, takes him down, has an 80% blockage in the RCA, they PTCA/stent, and he does fine (exept for that pesky little sunburn on his chest.)
  4. by   AngelGirl
    A definite squeaker!

    Some people have no idea how close they are to death (as in having chest pain since the DAY BEFORE). I guess that he (or his wife) experienced the "sense of impending doom" and acted on it. Good for them. And very fortunate that your staff acted so quickly!

    I was working in CCU one night when a man in his late 40's with CP came up from the ER. He had wakened at home from a deep sleep, sensing that his life would soon be over if he didn't get some help.

    He's woke his wife, who called 911 in the dark. It was at this point that he realized he was naked. With his near hysterical wifey on the phone, and an ambulance crew due to his home any moment, he decided he'd better at least get some clothing on. (You know how ambulance crews are...they never see anyone naked!)

    He crept down from the bed, crawled across the floor and, finding the clean laundry basket, sighed with temporary relief, as he pulled on a pair of underwear.

    By the time he reached CCU, he and his wife were both so tense, they were nearly immobile. The appropriate meds had been given, gtts were running, chest pain had lessened a bit and the cardiologist was on his way in. But the potential for a positive outcome was hampered by the stress these people were carrying.

    It was at that point that the charge nurse pointed to the man's mid-section and said loudly "AND WHAT IS THIS?!!!"

    We all looked at the same time and burst into laughter, realizing that this poor guy had, IN THE DARK, pulled on a pair of his wife's pink lacy underwear!

    Soon, even the man and his wife were laughing! Tension eased, and the his heart kept ticking until he reached the cath lab. Whew! I think that underwear saved his life! :chuckle