"Hey" the security guard was standing at the counter where I was charting. "There's a lady outside who needs some help getting her husband out of the car."
I got a wheelchair and followed him out front to the ambulance bay where a woman was standing next to a minivan literally wringing her hands and crying.
I went around to the passenger side of the vehicle. It has long been my belief that the people most in need of an ambulance usually come by private car and one look inside told me that this was one of those guys.
"Go inside and grab the first nurse you see and tell them to come out here with a gurney and some help." While he was inside I asked the woman how long her husband had been like this. 'This' was obtunded. A good nurse can tell with one look when someone is really sick and 'this' was it. According to her, he had been ill yesterday with flu-like symptoms and was okay when he went to bed last night. He had awoken her this morning thrashing around in delirium.
We got him out of the car and onto the gurney. Truth be told, we manhandled him out of the car, he was dead weight. There is no good way to get someone out of the car that can't help you. I still can't imagine how his wife got him in the car. Through the pneumatic door and into the 'crash' room, yelling for a doctor, respiratory and xray. The patient was hot to the touch and moaning incomprehensibly. As we cut away his clothes we saw the petechial lesions on his arms and legs. Any good critical care nurse worth their salt will be able to identify Meningococcemia, and here it was right in front of us.
Initial BP was 69 systolic, HR was 167. Lines were started and fluid boluses given. The patient was quickly intubated and put on the ventilator to protect his airway. BP remained low so powerful vasopressors were started and the shock team was called. Two doctors and three nurses were running non-stop hanging drips, inserting lines, monitoring vitals in an intense effort to save his life.
Before long he was whisked off to the ICU, slightly more stable with a blood pressure of 88 systolic on high dose Levophed. I found out later that he did survive but had a 4 month long ICU stay and lost all of his toes. Surviving this deadly illness does not mean returning to your previous level of function or quality of life.
As deadly as this disease is, employee health didn't want to treat the staff, stating the disease is only transmitted with close personal contact. Maybe so, but my peace of mind is worth the price of that one Cipro tab. Sheesh.
14 comments:
I'm glad the gent came out of everything ok but not providing you with protection, yikes! ;(
Oh, they gave it to us eventually, but they didn't want to.
Forgive me: Your employer sucks. As an agency nurse I was once tracked down to be given a round of rifampin after exposure to one who turned up with meningitis.
ERNursey- not that this is relevent to this posting, but after staying up pretty much all night reading your blog and others, I have decided that you should write "Nurses Bill of Rights." The Patients have one that hospital staff are expected to adhere to, no matter the personal sacrifice such as abuse, violence, humiliation, antagonization, or general nastiness the nurse must suffer in order to keep "customer satisfaction scores" high. They say that hospitals are customer driven businesses. I thought they were places people went to get medical care...
Anyway, I thought you would do the best job. Thanks!
-a fan
Thanks anonymous, that is very flattering and a great idea. I'm going to think about what should be included.
Babs, you don't have to tell me my employer sucks, that is not a huge shock to me.
At my hospital:
A patient with undiagnosed TB shows up in the ER in August; diagnosis of TB confirmed some time during his hospitalization.
ER staff who had contact with said patient contacted in January for possible treatment.
Um. Yeah, that makes sense.
ERnursey,
That is just HORRIBLE!
That poor patient (and his wife)!
And... you guys! Being denied assistance until management finally gave in!
Insane!
I just remembered that you wanted to know "where" I work given my killer staffing rations. Would it be possible to exchange that information somewhere more non-blog/private?
I understand that now they vaccinate college students for meningococcus, I think they should probably vaccinate health care workers too.
great case! very unfortunate!
Spook, I didn't want you to 'out' yourself, I just wanted to know what state to avoid when I start traveling.
Before getting a Meningococcal Vaccine look at this
http://www.vaccineinfo.net/
immunization/vaccine/meningococcal/
meningococcal_college.shtml
nyc ems: That link contains dangerous misinformation, implying that the vaccine does more harm than good and that meningococcal disease isn't very dangerous. Nothing could be farther from the truth, as this very post demonstrates.
ER Nursey: you might want to consider monitoring and/or deleting dangerous altie nonsense like that.
Hello all,
OK so I stumbled uopn this site and I suppose the timing was just right! NYC EMS... are you nuts? I had Meningococcal Disease when I was 22 (2003) and went into severe septic shock. My kidneys were already failing by the time I got to the ER. Blood pressure averaged 40/20 for too long and massive amounts of vasopressors caused necrosis of my limbs. My WBC count was over 80,000 and then fell to 100. I was on full life support for 2 weeks and had a bilateral hemorrhage from my adrenal glands.
I also lost both of my legs below the knee. By the grace of God somehow I stayed sane but can you imagine what my family went through? My parents called my priest in to give me my last rites when the doctors told them I had a 20% chance to live. Can you fathom having to do that for your child?
For 2 weeks I was in a coma, with multiple organ failure, bloated up, and dying. My entire body turned purple because I also had Disseminated Intravascular Coagulopathy. I have large scars and skin grafts all over my body.
I had blood transfusions at least daily.
So, yeah, obviously I woke up... but I woke up to months of surgery only to end in amputations that made even the surgeons cry. Then months of rehab and my adrenals never recovered so I have permanent adrenal insufficiency. I am sick all the time.
Meningitis is not just a cold, or something that goes away once you survive the acute infection. It is sort of like a hurricane. Maybe we don't get hit by them often, and some places don't get hit at all. When, we do get hit, though, people run... they evacuate, and they board up their houses and once its all over, sometimes there is nothing left.
If we had a way to prevent hurricanes and the state of Florida, or Texas, chose not to take the necessary steps to prevent them, wouldn't everyone think they were crazy? Kids are more important that houses, or belongings, or anything for that matter. No child should die from a vaccine preventable disease.
Oh yeah, and the medical bills, and not being able to work for nearly a year. My parents were able to make things work but it wasn't easy. Some families can't make things work, though. I know a woman whose children were close in age like my brother and I. The daughter got sick, and then a year later the son committed suicide. Vaccines save more than just lives.
The thought that a shot could have saved her or any other parent that kind of life, eats at me, and her, and many doctors. See, the funny thing about me is that I was educated about meningococcal disease. My mom is a nurse practitioner. I was not at home when I got sick.
I had mere hours of symptoms, not really different than the flu. The only reason I knew to go to the hospital was the petechial rash. I knew it probably meant meningitis. The thing is, education is not enough. Kids die in hours, especially if they only have septic shock and no symptoms of meningitis.
There is not a day that goes by that I am not reminded of how fortunate I am to be alive... Waterhouse-Friedrichsen syndrome (the adrenal hemorrhage) is almost exclusively diagnosed upon autopsy.
The last thing I would like you to ponder is what about me, as the victim? I mean, obviously it affects everyone around me, but what does it do to me? What if I am a 17 year old cheerleader who desperately wants a normal social life, but since I am in renal failure, I spend my free time hooked up to a dialysis machine? What if I am an independent 20-something and suddenly have to rely on everyone else for even the most basic of functions. What if I have to try to comprehend why I was chosen to both of my legs have to be amputated from a preventable illness?
I was in the best shape of my life when I got sick. I was 2 days away from leaving for ARMY basic training. The irony is that had I left, 2 days later, I would have had the vaccine!!!!!!!
www.meningitis-angels.org
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