Hello! June 11, 2008
Posted by keepbreathing in Uncategorized.trackback
I rarely get startled or surprised at work any more. It’s not like I’ve been doing this for 25 years or that I’m some jaded, thoroughly experienced therapist. Compared to a lot of the people I work with I am but a rookie. But I have a good grasp of reality and a fairly unassuming personality, and as such few things truly take me by surprise.
Today I got surprised.
I was in the ER assisting one of my comrades when a passing doc demanded an ABG on a recently intubated patient. Since this is a reasonable request, I prepared an ABG kit and sauntered into the room, introducing myself to the patient’s doting wife and her companion. I explained why I needed and ABG and I answered their questions about the ventilator and the endotracheal tube, which nobody had yet explained to them. I noticed a pump with a diprivan bottle hanging and I took note of the completely slack appearance of the patient. Should be an easy stick, I thought.
I bent down and readied the patient’s wrist.
“Sir, I’m going to get some blood from your wrist.” The patient’s pulse boomed beneath my fingers. I pushed the needle into the skin–
–and with the force of the ocean crashing into a beach house during a hurricane this 300-pound, six-foot-plus patient came out of the bed. His eyes popped open and he sat bolt upright at 90 degrees to the bed, legs flailing and arms waving as his eyes bugged out of his head. I swore like a longshoreman and instinctively placed my palm in the center of his chest and pushed the patient back down onto the stretcher*. As suddenly as he had sat up, he stopped; the only difference from his previously placid appearance was that his eyes were still open and bugged out. His poor wife was in hysterics and the nurse was as thoroughly surprised as I was.
I have never had that happen to me. I’ve had people wake up and I’ve certainly seen more than a few patients who wake up The Wrong Way. But never, not once, have I had somebody go from “coma” to “screech” in half a second like that.
Every now and then I guess a surprise is good for you.
*this sounds cruel but if I had let him go he could have fallen, self-extubated, or otherwise injured himself.
Yowza!!! I’ve never had that one happen either. I’ve had patients that I was told were unresponsive JERK when I stuck them even after being told I was going to stick (never know when they hear or not) but never that reaction. Holy cow! YOUR heart must have been beating a thousand times a minute in that moment!
I would have almost peed myself. I’ve been kicked in the head while doing blood gases, but never THAT!
Perhaps an adjustment to the propofol dose is in order, at least before another attempt at an ABG.
The stiff arm to the chest works well, even on family members. It can put them back down in their seat and discourage them from further aggression, because you feel pretty silly having been placed in a seat. I’ve never hit a patient or family member, but this has been pretty effective for me.