February, 2006 Archive

February 2, 2006, 1:04 pm

Lesson Learned

Medics have been called.

Except there weren’t medics in the ’50s, and this guy in white is injecting Methadone on scene.

The patient obviously didn’t faint because he has the famous “head in crook of arm” sign. There is a police officer holding off the hordes in the background, but no sign of an MVA. And guy-in-white doesn’t seem to be too concerned about C-spines. Good info on methadone in the ad, though.

But wait!

Massengill?

Don’t they make douches?

A methadone douche?

Ladies, would YOU want to feel fresh as a daisy all day with a narcotic, anesthetic douche?

Doesn’t that sort of, to put it gently, defeat the purpose?

You’d feel fresh all day but you’d be too stoned to care!

hhhhhhhhhhhhh

People often run into our emergency department in a panic, bringing with them a friend who is exhibiting an altered level of conciousness.

The patients are usually female, underage and intoxicated. The petite ones get carried in, others are placed in a wheelchair and are observed to be slumped over on arrival.

They arrive with a bevy of friends who were at the same function and are scared to death; so scared that someone has actually called the parents.

We make sure the airway is protected, do a tox screen to make sure that we are only dealing with ETOH, hydrate the patient and when they can ambulate, we discharge them and leave further “treatment” to the parents.

(It’s a good time to give some education to the friends regarding alcohol consumption, too. They tend to be rather receptive when they are truly afraid a peer is dying.)

hhhhhhhhhhhhh

This time was different.

A gentleman informed the desk that he needed a wheelchair for his daughter, who was not feeling well. He had been called to come and get her from a party. I took the wheelchair out to the parking lot and the woman (she was in her early 20s) ambulated steadily to the chair. Hmmm….they don’t usually do that.

She was slow but oriented to person and place, warm, dry and denied any medical problems. No allergies. Her vitals were OK, except for a slightly elevated respiratory rate. She was a bit “glassy-eyed”, and occasionally I had to get her to look at me. The main thing was she took forever to answer a question and moved like an old VCR tape in slo-mo.

She also had a flat affect, just barely emoting enough to get angry when I asked her, for the third time, what drugs she was on. Or how much alcohol she had been drinking.

None.

“You are not acting normal,” I said. “And I am concerned.” That’s when Dad broke in with this rather startling piece of information:

“She is drinking tons of water and Diet Pepsi and she always seems to be in the bathroom.”

Oh no…..

I could have grabbed a finger-stick glucose level in triage but all of a sudden I knew what I was dealing with.

Hyperglycemia. New onset diabetic.

We grabbed a room, called the doc, took a finger-stick glucose that just read “High”. As well it should; the actual lab glucose was over 1000.

Normal for our lab is around 70-110.

Had this patient been alone, without other people to notice her mental alteration, she would have gone into a diabetic coma. She would have died.

She didn’t. We admitted her and she was discharged a few days later, with a life that had been radically altered in terms of lifestyle and responsibility for her own wellbeing.

I once watched a 25-year-old die of new-onset diabetes when I worked in ICU.

I felt abashed. For the arrogance of assuming her altered state was drugs or alcohol. For not believing her when she denied both. For not picking up on the elevated respiratory rate. For not getting an immediate fingerstick in triage on an “altered” patient.

For having to be reminded that in emergency nursing, no patient is “routine”.

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February 1, 2006, 2:34 pm

You Shake My Nerves and You Rattle My Brain – Emergiblog Goes Snarky

The year is 1956.

Your son is playing “cowboys and indians” with a bit of Daniel Boone thrown in. You have just completed vacuuming your entire one-story, one bathroom, formal dining room with the blond dinette set, three-bedroom tract home in the suburbs. You are sitting with a cup of coffee and reading the papers. You attended the local university for six months before receiving your Mrs. degree and have just read in the paper that Elvis may have a girlfriend. The highlight of your week is watching Bennett Cerf on “What’s My Line” Sunday nights on CBS.

You just can’t take it anymore!

You need Serpasil! By CIBA!

After exhaustive research (in other words, I googled it in one click), I discovered that it is an antihypertensive.

It is known generically as “reserpine”.

I used to give it long ago in Coronary Care. I didn’t get the connection until I read that it also works on “severe agitation in psychosis”!

Serpasil: for when the fifties weren’t so nifty!

hhhhhhhhhhhhh

Caution! Uncharacteristic Snarky Post To Follow!

Seizures are extremely scary events to witness, be they due to pediatric fevers, not yet diagnosed brain tumors, head injuries, delirium tremens (DTs) or epilepsy. It is quite tramatic for not only the patient, but the family and witnesses as well.

They are pretty much impossible to fake. If you have ever seen one, you know what I mean.

But, in the ER, we occasionally have our share of amateurs actors and actresses who believe they can play the role well enough to win an Emmy for “Best Performance by an Actor or Actress in a Seizing Role in a Medical Drama Set in an ER”.

And so…

In the interest of public service, I should like to make the following announcement:

You are not having a seizure if:

  • You can call out, “Hey Nurse! I’m having a seizure!”
  • You act like a member of the SpongeBob SquarePants Fan Club and
    • “drop on the deck and flop like a fish” .
    • Defined as: flipping your torso from side to side while lifting arms and legs three feet in the air and slamming them into the gurney.
  • You miraculously avoid all potentially harmful surfaces (like siderails) while doing the above.
  • You can speak full, coherent sentences with clear speech
    • while doing the above
    • including cussing out the staff who are trying to assist you in your distress.
  • You place your head on your arms
    • if your episode occurs on the floor
    • you are less likely to get a headache that way.
  • You only experience the above when certain significant people enter the room
    • specifically law enforcement personnel of various agencies
    • a member of the opposite sex who has decided that evening to release you from any obligations you may have had as a couple.
    • Your parents, who have just found out you and marijuana have an ongoing relationship
  • You immediately reach down to cover yourself when you realize your skirt is pulled up to your waist.
    • This is not sexist as I live in near San Francisco.
    • You can never assume who will be wearing what on any given day.
  • You experience no post-ictal alteration of your consciousness level.
    • You sit right up and marvel at how horrible your seizure experience was.
    • And did we notice how your head went up and down on the pillow, like, twenty times.

Yes, as a matter of fact, we did notice!

And now that you are through with your performance and your trillion-dollar head CT that-had-to-be-done-to-cover-everyone’s-derierre has been completed, here are your discharge instructions.

Remember, we’re here to help you, twenty-four hours a day.

And don’t worry about that trillion-dollar CT bill. The government will add the approximately $150 a month that they they take out of my paycheck to cover your medical bills and add it to everyone else’s involuntary contributions so that you won’t have to worry.

You’re welcome.

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About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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