Friday, May 15, 2015

Well. That was hairy.

It was a normal day in the CCU at Sunnydale (Hospital for the Hellmouth). Admissions, discharges, multiple procedures requiring conscious sedation, doctors getting all fumble-fingered with the new order templates, the bathrooms out of order.

It was normal until Courtney showed up. Court stands barely five feet tall, might weigh a hundred pounds soaking wet, and is the finest nurse I know. She's worked in every critical-care area there is, from trauma to burns to places where twelve drips on one patient are the norm, and once crawled into a crushed car--while seven months pregnant and on a flight crew--to retrieve the unconscious victim of an MVA. She is the bomb.

Normal became fantastic when she stopped by. She had the role of emergency responder that day, carrying her bag with all her magical devices in it. When somebody goes bad, instead of calling a code (that is, if they're still breathing), you call the emergency response person. And when it's Court, you know you're getting a quality response. Plus, she's funny as hell.

So I was glad she was there when the family member of one of my stroke patients stepped out into the hall, grabbed his head, and then passed out in his sister's arms. Sister lowered him to the ground, screaming for help, and Courtney and I were there before he'd hit the ground. I turned him on his side, Court hit the panic button that would call everybody to help, and Kitty got the crash cart.

And then he started to seize. Ever tried to start a line in a six-five man with crap veins while he's in the middle of a tonic-clonic seizure? I don't recommend it as a fun way to start your weekend. I couldn't get anything, so I handed him off to Courtney, who found a vein in his arm that I had tried for and missed. Kit was setting up suction and popping a nonrebreather on him at that point, and I was trying to keep his head from slamming into the wall any more than it had already.

At that point respiratory showed up. And pharmacy, and the internal med PA, and every damn nurse on the planet. Courtney was busy taking care of our now-patient, so I was the one who got to direct things: You, call 911 and get us an ambulance. You, call the ED at Holy Kamole and give 'em the heads-up on this dude. You and you, get the vitals the machine is rattling off every minute. You, stand by with your bougie and tubes. Who's recording, even though this isn't an official code? Nobody? Okay, you do that. You, go get a gurney and a lift board so we can get this dude off the floor. Where's Ginny the Inappropriate Chaplain? You, page her. Get her up here.

All done slick as snot, with no raised voices, no panic, no missed steps. He seized four times in five minutes. We gave him Ativan in an attempt to stop the seizures, and he ate it up. It took 5 milligrams of the stuff (for nonmedical types, that's two-and-a-half to five times what it normally takes) to get him quieted down.

Then the EMS guys showed up. I love paramedics. They started two more lines in a literal minute, started fluids, got the guy's airway protected, and wheeled him off.

And, after we all took a deep collective breath, Courtney sat down in the station and said, "Okay, y'all. That went well, but what could we have improved?" and we had a debriefing session.

It was the smoothest emergency response I've ever seen. I'm really proud of all of us. Nobody's hair caught fire, nobody panicked, nobody was just standing around with nothing to do. The people who had tasks did them, while the people who weren't tasked with something melted away to go take care of their own things. It was fucking model.

And it happened at 1805, and all of us got our charting done and got out on time.

I work with good people.


bobbie said...

Don't ya just love it when it works right!?!

Allison said...

Why did you have to ship him off to Holy Kamole? Why couldn't he stay where he was? Just curious, non-medical person asking the question.

Jennifer Thorson said...

High fives all around.

For those of us who don't work in hosptials, could you explain why someone having seizures in one hospital would need transport? Does your hospital not have an ED? Thanks.

jimbo26 said...

WOW , very , very nice one . Well done to all . :-)

cowango said...

Indeed you do and congratulations.

cowango said...

Yes, he is shipped off to ED because he's not an inpatient. You can't just plop someone in a bed and begin treating them. Their immediate job was to get him to the nearest ED, which may not have been their hospital. Since he was a visitor and on hospital property they were obliged to get him to that ED, which in their case meant calling 911. In my case, we'd have flung him on a gurney and transported him stat to our own, bypassing the waiting room into an open bed there, and of course notifying our ED of the impending arrival.

Jen ♥ said...

You guys are amazing. I don't know how you stay so cool under pressure.

I just love these stories.

Dr. Alice said...

How's the fellow doing? Did you ever hear anything back?

(Very nice work, BTW!)

Jessie said...

Smooth running codes make all the difference! Im a newer nurse and I have had my fare share of chaotic codes…ha

MSNurse2U said...

So reading that... I'm officially jealous. I want to learn that kind of response. Are y'all done hiring?