Saving Lives, 1 cup of Gatorade at a Time!

Orca, ADN, ASN, RN · Sep 2, 2014

A few come to mind, from my days working the yard at a male medium-security state prison.

The first we received a man down call on due to abdominal pain. When I reached the unit this inmate was in a fetal position and in obvious agony. It took three of us to straighten him out enough to get him on the board to take him back to the infirmary. I asked him pretty much everything about his GI system - whether he had similar problems in the past, when and what he last ate and so forth. His abdomen was tender and when I took his vitals his temp was almost 103. I called the physician on call and he asked what I wanted to do. I said "I don't like this. I want to get this guy out of here." We sent him to ER by ambulance, and he was rushed to surgery where they operated just before his appendix burst. I found out later that he had presented during the previous shift with symptoms almost as severe as what I witnessed, and he was turned away and told to write a kite to see the doctor.

The second was an inmate I saw right at the end of my pill pass on the yard. I had known this inmate for several years, and he wasn't a complainer. When he came up and said that he didn't feel good and was having trouble catching his breath, I told the unit officer that he was coming with us. I took him to the infirmary and examined him. His lungs sounded clear, but his O2 sat was so low I took it again to make sure that the equipment wasn't malfunctioning. It remains the lowest O2 sat I have ever seen in a conscious patient: 44. I sent him out to the hospital where he spent about a week being treated for a severe respiratory infection.

Case #3: I get a call from a unit officer who says that he has an inmate who says he is "about to have a stroke". I thought, probably bogus, but I will get the officer off the hook by at least seeing him. When the inmate came down, his tongue was severely swollen and his gait was unsteady. Took his vitals, all off the chart. Checked his medical file and saw that he had a doubling of his dose of Risperdal earlier in the day. That meant one thing: neuroleptic malignant syndrome. If I didn't get it under control we were going to code this kid. I called the doctor and asked for a stat order for Cogentin 2mg IM. Within 20 minutes the inmate's vitals were back within normal limits and the tongue swelling was gone. I had seen one other case earlier in my career (caused by Haldol) when I was working hospital adult mental health, so I knew exactly what I was dealing with.

Inmates play so many games on us that we often get jaded and we begin to believe that they are lying all the time. However, I learned long ago to trust my instincts.

mikethemurse, BSN, RN · Sep 3, 2014

thanks Orca for being the first to share some of the good outcomes...I'm at work now, busy night just enough time to scarf some food between emergent stuff, well duty calls thanks again. mike

HPointon · Dec 5, 2014

I work in a smaller county jail where we house on average 50 inmates on any given day. I am the only RN at the facility and I am only here 4 days a week. My doctor comes in once a week as well as our mental health nurse. We had an elderly IM brought in who was MI and honestly did not belong in the jail. This IM was back in holding as a safety precaution to himself as he would bang his head on the wall, urinate on the floor (then wipe it up with his sock, and refuse to hand over the sock), smear feces on the wall, and so on and so forth. I was informed by staff that he had an open wound on his ankle and after digging through his medical information I found out that he was also a diabetic. When I went back to check out his foot he would not let me close to him. He said the only way he would let someone take care of his foot was if it was a burn nurse at our local hospital. I had to stand 20 feet away and he told me if I couldn't see it from there I was blind. He also refused to take any of his medications or allow staff to check his blood sugars. After consulting with my MD we decided that it was in his best interest to send him to the hospital to have the foot taken care of as he was urinating and defecating all over the open wound. While he was at the hospital he underwent a psych consult. However, his foot was bandaged and he was sent back to the jail. I was extremely appalled at this and immediately called the ER to find out why he had not been placed on a hold. The answer I got was even more disturbing. I was told (by the MD who did the eval) that he met every qualification to be placed on a hold but they had previously tried to have him committed and "our county attorney" didn't support it and let it fall through. I explained, rather bluntly, to the MD that it was not his personal decision who gets placed on holds and that if he met all the criteria for a hold that he should be placed on one, regardless of what "our county attorney" has to say about it. I told him that when he chose to become a doctor he took an oath to provide medical care to those who need it and he was failing this man because everyone else had. So at the end of the day the county attorney was contacted and so was social services and everyone was on board to have this man committed so he could obtain the medical/mental health services that he needed. He, in fact, was committed and sent to a mental health facility. He has not returned to the jail as an IM but he has come to collect his things and he seemed to be in a better mental state. I don't know that I would say I saved his life, but I gave him another shot at having a "normal" one.

RNforLongTime · Dec 8, 2014

But he denied doing that and reported only a severe head ache. Neuro check ok ish, but he was only smiling with one side of his face, no droop. So now I think bells palsy? so I call the on call md and she says that sounds right, and to keep him in the infirmary on neuro watch and he will f/u with md sick call round 7 am less than 3 hrs away. so Im cool with that and tell the inmate and C/Os that he will be moving. So he asks for some gatorade, (we give it to our w/d guys usually) so i give him a big old cup and he picks it up and instead of bringing it to his mouth he pours it down the front of his shirt. Then he uses his other hand to drink it without a problem. At that point ( after asking him what he was doing) I say hold the phone...I'm calling 911 and this guy is outta here. I wasnt sure what was going on with him, all I knew was that now he had a decrease in coordination and that is never a good thing.
So to make an long thread longer...the Pt wound up having a sub dural hematoma, with an 8 mm shift of the midline and an abscess in his brain. less than 1 hr after leaving the jail he had an emergent craniotomy, and then 2 days later another one. I heard from one of the Lts who knows the Pts family that he is doing well with minor deficets on the left side, but he is alive! If he had gotten to the hospital any later he wouldnt have made it. ....
.

Just curious....why was the first thing that came to your mind Bell's Palsy? After reading your description of the inmate's signs/symptoms, the FIRST thing that came to my mind was some kind of stroke going on.

We had an inmate who had similar s/s as yours...Nurse went to assess him. Told him he was fine, just had Bells Palsy. Next shift (a few hrs after initial assessment), another RN goes down after being summoned by an Officer who told her that he thought the guy was having a stroke!! Well, guess what? THAT'S EXACTLY what it was! Inmate successfully sued the institution & received monetary damage due to the effects of the stroke and delay in proper treatment.

mikethemurse, BSN, RN · Dec 8, 2014

rnforlongtime, I didn't think CVA b/c no other symptoms present, and no other risk factors, aside from the decreased control over facial muscles, no droop, no slurred speech, 26 y/o with no hx drug use, vitals stable. I did speek with an MD who independantly stated the prob dx of bells. Actually my first thought was that the pt took another i/m meds, and was having some type of dystonia. the important thing is that i saw a neurological change cva, bells, or what it turned out to be, and took action in order for him to be taken care of, I didn't just send him back which was the point of this thread, to list stories that had good outcomes because of strong assessments of corrections nurses. especially because of all of the negative stories in the media about corrections nurses dropping the ball in pt care, I thought it would be good to improve the moral for all of those unsung heros working in a very difficult area of nursing. not sure if that answers the question let me know.

RNforLongTime · Dec 8, 2014

It does. Just don't want to see anyone get sued or have to defend their license (which is what happened to the nurse in my scenario). I was taught to always first think stroke or brain attack before something like Bells...as from what I know, it's not that common.

mikethemurse, BSN, RN · Dec 8, 2014

Again, like in any other situation you have to take the whole patient into account. As a rule I error on the side of caution. With the limited resources most of us have it is easy to mistake PE for MI or Bells for CVA or cellulitis for DVT. Our job is not to diagnose but to assess if our patients are in real distress and take action. The main reason why nurses get jammed up in law suits is negligence, being aware of a real danger for loss of life or limb and failing to act. That is why I see every complaint. I would rather waste 5 mins of my time than to be in front of a review board attempting to explain why I failed to act. (Please forgive spelling/ type... Now on 24th hour awake)

RNforLongTime · Dec 10, 2014

Oh I understand that....and when I don't know, as I cannot diagnose (technically) I call the Medical Director, a DO, and let him make the call whether or not the inmate needs sent out. If he decided otherwise, I make sure I CYA by documenting, documenting, documenting....If I have an inmate c/o chest pain, in our treatment room in Medical, we have a 12 lead EKG machine..I hook him up and look at it. I have 17+ years of nursing experience under my belt all of which was in acute care, with 12 being in critical care. (my CCRN certification expires next yr). I realize that not all the nurses I work with, have my level of experience....one of them, the prison was this RN's FIRST nursing job....not sure that's a good thing, imho.

My hospital that I left, just went through Stroke Certification to gain Stroke Center status...and the 1 thing I was told was not to go looking for zebras (i.e.--Bells Palsy) vs stroke.

Our Prison system has what's called Nursing Evaluation Tools...that basically tell you what to assess with the presenting problem.

RNforLongTime · Dec 10, 2014

My story wasn't really a 'save' per se...this I/M had a hx of esophageal cancer....comes up due to coughing up blood x 12hrs...coffee ground emesis...Looks really pale and emesis reeks of GI BLEED to me. O2 sat 88% on Rm Air...so I slap some 02 on him and call the Dr (as it was the Friday MORNING after Thanksgiving so the Dr wasn't there) Tell him that I think its a GI bleed....admit to infirmary for 23 hr OBS...he'll see I/M in the am.....the PA had come in and the Infirmary RN tells PA about this pt...PA orders blood work to be done on Monday (as that's when the pleb will return)...long story short...I/M's VS continued to deteriorate...ends up getting sent to the hospital on evening shift.....I/M ends up on a ventilator....family got 1 final visit with him before they withdrew care. Initially the IM didn't WANT to go to the hospital because that's what I'd told the Medical Director ought to happen. The inmate looked THAT bad.

I was right but it didn't change the final outcome.

nurseLit5e · Dec 17, 2014

We have a similar situation here at our prison, inmate comes in c/o sever headache, numbnesss tingling in one arm, and the R.N. brushes him off... well after many Dr. visits for same complaints, they find a large mass in his brain and wanted to do surgery on the spot! (local hospital) the inmate was floored with all this information (he also had a midline shift) and wanted to think it over, the surgeon said do it within the hour or its off! so the inmate said no way, and will be going back for sugery, as his options were not good. On yours, good catch!

RN In FL · Jan 19, 2015

Here's one. Female inmate shows up in booking for medical intake. I had 2 other intakes. Officers tell me She is a doozy intoxicated, to go ahead with the other 2, because she was too intoxicated/slurred speech to answer questions. I look though cell at her. They had her laying down. We are contracted in Healthcare to the jail, have to get permission to treat, consents signed by inmates. I proceeded to do the intakes. Officer come to stating inmate still sluggish after 30 min. I check on her again. Still no intake.., sluggish, VS WNL, PERL, but officers stated she was not this sluggish up first entering the jail. I called the medical director and HSA. Agreed to call 911, nothing I could do for her at the county jail, got her outta there for futher assessment. INTAKE NEVER DONE...I followed up the next day, IM had ASA toxity. Anyhoo, I was terminated....officers and the Sherrif felt my standard of care was insufficient, because I didn't attend to her efficiently. So they are calling the shots are the county jail. Had survellience, without audio.