Last year near the beginning of my intern year, I was awed by one of our second years, now chief resident, who responded to a patient who had collapsed in the waiting room. The nurses brought the patient to the closest open bed and called for Steve (not his real name) by name. Steve stepped into the room and quickly assumed command in a calm, cool fashion. I was so impressed and wondered if the nurses would ever call me by name like that, and doubted if I could ever take command like he did with such a calming influence on the people present in the room.
Tonight, the charge nurse calmly walked over to the physician desk, called the attendings name, and said, “We need you.” She didn’t hear him. He said again, calmly, “We need a doctor.” I’ve been around long enough to know that when a nurse says, “We need a doctor,” that you go to the room quickly without asking any questions because there’s trouble in there. I followed him into the room. The attending stayed put, letting me assess the situation.
A three year old child sat bolt upright on the gurney, audible gasping wheezes coming from her throat. Her face was beet red, her heart racing at 220 beats per minute, breating 36 times a minute. Concerned parents and grandparents hovered. The little girls eyes roved the room at all the strangers fussing about. No history of asthma, but she had leukemia…and immunosuppresion making her very vulnerable to infections. My first thought was croup and I called for respiratory therapy to administer nebulized epinephrine. Initially, we had to hold her arms down so she could get the medicine and not push it away. I pointed a flexible hose with humidified epinephrine at her face as she screamed and cried which made her breathing worse. Within three minutes, she calmed down. The beet red color of her face turned to a healthy rosey color. The stridor stopped. She stopped crying. Her heart rated dropped to a more normal 150. Her respiratory rate dropped to about 24.
We had fixed her problem…saved her life in fact. It didn’t hit me until later. I had only seen one case of croup before and made a reflexive decision to give this little girl that medicine most likely to help. That’s what experience buys you, I guess…that reflexive action that can save someones life. It didn’t matter if it was anyphylaxis or croup, I had a hunch that the epi would be the biggest help…and it was.
Anther life saved…this is starting to become habit forming!