"Something's Wrong! That's Just Not Him!" | Nurse in Action

ER Waiting room rounds. Discover a too quiet patient. Can the nurse figure out the problem before it's too late?

"Something's Wrong! That's Just Not Him!" | Nurse in Action

"Go check the waiting room!"

I looked up sharply from the  ER nursing schedules I was doing. It was 10:30 p.m. I would be done by 11 p.m. Did I hear that or was it my imagination? There was no one in the office but me! I got up and stretched. Slipping on my white coat and stethoscope I walked out to the waiting room. It was packed. I stood by the security desk casually making conversation with Tony, the guard while my eyes swept across the big room. Hopeful eyes looked at me. My eyes stopped at the older African American  gentleman sitting quietly between four young white men. He was answering their questions in monosyllables. I saw them exchange worried glances at each other. I walked towards them observing the grey pallor on the man's skin.

"Something is wrong" ...

"Hi, I am Annie the ED manager. Who is the patient here?"

One of the young guy's piped up, "It's Mr. Gary!", and nodded toward the older gentleman.

"Hi, Mr. Gary! How are you?"

"I've had better days!", he mumbled.

"And, you are--?" I asked looking at the four young men.

"We are Gary's friends. We work together as caddies at the Green Meadows Golf Course!"

"OK! So what's going on? Why did you come to the ER?"

"Cause, something is wrong! This is just not him!"

"What do you mean?"

"Gary is very fun loving and is always joking around! He has changed in the last one month!"

"Yeah! Ever since the fall!", one of the other guys chimed in.

"What fall?" I asked casually as I watched Gary rubbing his temples.

"He fell backward last month. I think he slipped. He was checked out in the ER and was sent home. He's been different since then! He's very lethargic!"

"His balance is off and he vomited today!"

"Mr. Gary! Do you have a headache?"

"Yes! The worst headache in my life!"

"Have you been taking something for it?"

"Been popping Aspirins and motrins! Nothings working!"

History, Assessment and Action

"Let's get you in. I am going to triage you inside!" I grabbed a wheelchair and told his friends to wait outside. As Tony, the security guard, swiped me into the ED, I motioned Claire the secretary and asked her to send in for a stat registration to stretcher A1.

"Any medical problems?"

"I have a funny heart rhythm! Can't remember the name!"

"Atrial Fibrillation?"

"Yes!"

"Are you on coumadin or warfarin, which is a blood thinner?"

"Yes, 7.5 mg every night!"

I groaned inwardly. He could be a bleed!

I had Joan, the ED tech, hook him up to a monitor, get vitals and a stat EKG as I triaged him. Got Vilma, the nurse, to throw in 2 large bore lines in him and send labs including Type and screen.

I went over to Rick, one of the Attendings in the ED.

"Rick! We may have a bleed. Guy in A1, name's Gary, 72 years old, no allergies, had a fall 1 month ago and has the worst headache of his life. He has been taking Asprin, motrin and coumadin! A Perfect cocktail! His friends noticed a change in his behavior and brought him to the ED!"

"Great! Let's get a stat CT Head!" He quickly examined Gary while I called over to CAT scan and informed them. Within 10 minutes we were looking at the films with the neurologist who we paged - a large subdural bleed. It was a short matter of time before his airway got compromised! Gary was getting disoriented. He was electively intubated and arrangements made for his transfer to our main hospital Neuro ICU. Vilma gave report and Claire called for an ACLS transport. It was 11:30 p.m.

"He's like a dad to us"

I went outside to speak to Gary's friends!

"How is he doing?"

They were all anxious as they had not seen him for an hour.

"Well! He is stable and I want to thank you for being good friends!"

"What's going on?"

"Your friend Gary was behaving differently because he was having a bleed in his head! It was getting worse as it was causing a headache and Gary was taking medications for the headache like motrin and  aspirin that are blood thinners and made him bleed more, a vicious cycle. He is also on a blood thinner coumadin which worsened the problem!"

"Is he bleeding in the head?"

"Yes, the bleed is putting pressure on his brain and so we had to intubate him as it would affect his breathing at any point."

"He's on a ventilator?"

"Yes, he is. The good news is that his vitals are good but he needs to be transferred over to our main hospital for further treatment. Does he have family?"

"He has a sister in North Carolina but we are his family here!"

"OK! That's good! I will have Vilma, his nurse, keep you informed. If you can find out his sister's information, let Vilma know!"

"OK ! We will! Thanks, Nurse Annie!"

"Thank you! Gary has great friends in you! You saved his life bringing him in today!"

"He's like a dad to us! We just want him to be OK!"

Reflection

I smiled and walked away back to my office thanking God for the humanity those young men, all New Yorkers, showed to their coworker despite their age and racial differences!

As I headed out of the ambulance bay, Gary was being loaded up for the transfer by the ACLS team. The young men anxiously watched and planned to follow him to the main hospital. As I drove home, I reflected on the story of the good Samaritan and thought of the right choices those men made to help Gary! I wondered which of their Guardian Angel's spoke to me in my office! I had plenty to choose from! Thank God for good people in the world!

References/Resources

WebMD: Subdural Hematoma

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spotangel

About spotangel, DNP, RN, NP

Chronic Care Coordinator

Wife, mother, writer, friend! Love God above all!

24 Articles   519 Posts

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Specializes in Community health.

I love all of your posts and stories. They’re really interesting and you always do a great job of “setting the scene” so we can really feel like we are there. Thanks for the hard work you put into these. 

Would you consider using fewer exclamation points in your next post?  It’s a little distracting to have all the dialogue end with “!” (even though I understand that you are showing us that the characters are afraid/excited/upset).

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Specializes in ED, Tele, MedSurg, ADN, Outpatient, LTC, Peds.

Thanks . I will restrain myself. Appreciate the feedback.

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Specializes in Psych (25 years), Medical (15 years).

With all due respect to Community, your articles flow like a river and are a joy to read, spotangel. The worst enemy of good is better.

Or, as my Dad use to say,"If it ain't broke, don't fix it!"

Keep on keeping on!

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Specializes in ED, Tele, MedSurg, ADN, Outpatient, LTC, Peds.

Thanks Davey Do. I appreciate the feedback. I will keep on Keeping on.

I do get community RN's point.

To be honest, when I write, it just flows. Once I start,I seldom stop till I am done.

33 Years---lots of stories. Trying to write them all before I forget---.

 

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Specializes in Psych (25 years), Medical (15 years).
7 hours ago, CommunityRNBSN said:

Would you consider using fewer exclamation points in your next post? 

 

48 minutes ago, spotangel said:

I do get community RN's point.

If fewer exclamations are used, they're going to feel discriminated against and then the feces is going to hit the proverbial fan!

I'm hearing the rabble right now...

 

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Specializes in ED, Tele, MedSurg, ADN, Outpatient, LTC, Peds.

Davey Do! You always bring a smile. 
update on the pt

He had  cranial decompression of the bleed done with drains in place. Did not have any infection, clots or further bleeds. Neurological intact and walked out safe home with neuro, cardio and PCP follow up and home PT in 2 weeks! YES!

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