Thursday, May 31, 2007

IV Therapy Escapades - Part V

It didn't take me long to learn that I wasn't REQUIRED to attend resuscitations in the ER. That didn't keep them from calling me on occasion, though. Little kid with invisible veins? Call the NICU nurse. Yes, the one who thinks feet are good places to start IVs. Call her.

Really, I didn't mind because they always called me while I still had something to shoot for. Mostly they got the IV in one stick and I didn't hear from them. Once in a great while I'd get that page. Sometimes they hadn't tried, but only because the kid had been in a lot and the parents were feeling really stressed. Late evening, I'd finished my routine restarts, I was just waiting around for pages for stick-and-runs anyway.

And resuscitations. Everywhere but the ER. So when the pager went off about the same time as the "Code Blue, Main Lobby" I nearly experienced loss of sphincter control.

I'd been to a few adult codes, but in the lobby? Can't be happening! I couldn't bolt down the steps, because I knew I would need my cart. The one with all the catheters, IV fluids, tubings -- all that stuff. No drugs, though.

The wait for the elevator seemed to take forever. It was probably under a minute, but I needed to get there. Nobody else around when it arrived and, fortunately, it was an express run to the first floor. When I got to the lobby, I was glad to see that the scene was well under control - and that someone had managed to get a crash cart to the scene.

What I didn't expect was the age of the person being coded. He couldn't have been much more than 15. 120 lbs soaking wet (which he wasn't, except for the vomit). He'd been intubated and the IV was already in place by the time I got there, so all I needed to do was stay out of the way while they moved him to a gurney and off to the ER.

I got the rest of story later from someone who'd been one of the first on the scene. He'd been intubated because he wasn't breathing effectively, but they'd never lost the heart rate. His blood alcohol level was nearly 4 times the legal limit of 0.08. Drugs? Tox screen wasn't back yet, but with a blood alcohol level that high, who needs drugs?

He'd been at a party. The friend's parents knew there was booze and thought the kids were safer drinking at someone's house. They hadn't realized how easily adolescents can go beyond intoxication to alcohol poisoning. Nobody wanted to get in trouble, so instead of calling 911 when the kid started looking bad, they called his brother - who pulled up to the nearest door when he started vomiting. Fortunately, someone inside recognized how serious things were and called for help right away or the story might have had a different ending.

You can kill yourself faster when you mix drugs and alcohol, but you can do a pretty good job with alcohol alone. The LD 50 (fatal for 50% of adults) blood alcohol level is considered to be .4 An adolescent who isn't used to drinking can be in a lot of trouble with a blood alcohol level half that. Choking on their own vomit is just one of the ways an intoxicated person can get into trouble. Alcohol can interfere with the part of the brain that controls breathing. Blood sugar can drop to the point that seizures occur. Dehydration and electrolyte imbalances can result from prolonged vomiting.

The kind of rapid binge drinking that can result from dares, games, or hazing can result in very high -- potentially lethal -- blood alcohol levels. Someone who has consumed a large amount of alcohol can die if left to "sleep it off" because they will continue to absorb the alcohol already consumed and the blood alcohol level may continue to increase. If there is a reason to suspect alcohol overdose, call 911.

Fifth in an occasional series

Part 1
Part 2
Part 3
Part 4

1 comment:

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