My Overdose Patient

*WARNING* This story is kind of crude and talks about gross bodily issues.  Consider yourself warned.  Also, sorry it’s so long.

I originally started this blog as a way to remember my wildest patients in my nursing career.  This one is diffidently worth noting.  I was having a really good night.  I was in pod 3, which is my least favorite.  It gets the codes and mental health patients.  Plus it’s nurses station is smaller than all of the others, but there are twice as many people working in that area, so it feels cramped and every time I turn around someone is sitting in me seat and has their stuff all over my charts.  However, I had really good patients and none of my rooms had been full at once all night.  I had two mental health patients waiting for placement at another facility and all I needed to do with them was take their vital signs every two hours.  Security and our mental health people take care of everything else, unless they need meds, which mine did not.

At a little before midnight I got an EMS into my only empty room.  Lucky me, I had the only empty room in the entire ER at the time, well except for our trauma room that they leave empty in case we need it.  I grabbed a blank chart and waited outside of the room for the EMS crew to finish their work.  I already knew that she was an overdose on Lisinopril (a blood pressure pill), but knew nothing else.  I saw from watching while they talked that she would open her eyes and talk, but made no move what so ever to help move her 300 pound body over onto our stretcher.  After they finished one of them came out of the room to give me report.  She said the patient was groggy, but could answer their questions.  She had just been discharged from another ER the night before and had taken the entire months worth of Lisinopril in the past 45 minutes.  She was a frequent flier and had a long history of mental problems.  The EMS crew was planning on taking her to the ER she was discharged from the night before, but they were full and couldn’t take her.  Lucky me.  Apparently she had also been in our ER the week before as a psych patient, the mental health guys remembered her.

I could smell her before I even walked into the room.  I don’t even know how to describe the smell.  Not BO really.  Just stink.  This woman was only 33, but looked more like she was in her 50’s.  The sheet she was laying on top of was covered in dirt, was wet from where her wet socks touched it, and had bits of leaves and who knows what else.  She looked like a car crash patient who had lade on the ground before being brought in.  But, she had been brought in from her house.  She had lifted her shirt up to her chin and was scratching underneath her boobs that hung to either side and was also digging at her crotch.  Later, I would know why it itched so bad. YUCK.

She had her eyes closed and didn’t say anything to me while I worked on hooking her up to the monitor so I could get her vital signs.  She just kept singing for Charlie to come get her and take her home so she could play with his willy all night long.  Lovely.  The EMS got blood pressures on her of 105/60 and 100/50.  The first one I took…..70/32 and dropping quickly.  I believe the next one five minutes later was 60/20’s.  She got to us just in time.  I never did find out if she was the one to call 911 or not.  I quit getting information and hauled my butt to find a Dr.  I ended up triaging her as a level one, which is usually reserved for coding patients, but she was going to code any minute if we didn’t do something.

One of the other nurses came back in to help me get a second IV started and drawl blood while I hung a 2nd bag of saline and got the charcoal ready for her to drink.  YUMMY!  I still have remnants of it under my finger nails and it won’t come out.  At that point she was screaming for something to drink and swallowed all of the charcoal like it was the most refreshing lemonade ever.  At least I had no problems getting her to drink it and amazingly she didn’t puke it back up at me.

A few minutes later she was screaming that she wanted a drink and would not shut up.  Finally Jeff the tech walked in and screamed “MA’AM, You are not getting a drink right now!!”  The other nurse and I were outside of the room and just lost it laughing.  Jeff is usually the sweetest guy ever and can lay it on pretty thick for any patient who is upset.  When he walked out we were still laughing at how um, stern he was with her.  The other nurse said “well, I guess your customer service just went out the window with that comment.”  haha He was then upset that he was so mean.  We were like, don’t worry she won’t even remember.  Sure enough, 5 seconds later she was yelling for a drink again.

I spent the next two hours in her room trying to keep her covered since she seemed hell bent on being completely naked.  I was also taking her blood pressure every five minutes and trying to get caught up on my charting of everything we had done.  About an hour after she got there her grandma showed up.  Surprisingly, she was well dressed and looked normal.  She was a little too calmed considering the situation though.  She was probably used to seeing her granddaughter like that.  I also don’t think she really understood that she could possibly die, the pills still had hours before they hit their peek.

Her IV that the EMS has started eventually got ripped out and I was trying to draw some more blood because I needed one more tube to look for any other drugs that may be in her system.  As I was in the room the monitor took her blood pressure and it read 49/? meaning it was unable to detect the bottom number.  The prior reading had been decent still 70s/30s and holding steady.  I’m not sure why she dropped all of a sudden.  I poked my head out of the room and yelled for the other nurse to go find the Dr NOW.  We paged for the Dr and the other nurse quickly started helping me get yet another IV while I ran for more and got the patient basically standing on her head in the bed to get blood to her brain.  At this point she was pretty much non responsive and snoring away.  Later I learned that I liked her better that way.

We started her on a dopamine drip to help raise her pressure.  The bad part about it is, it also speeds up the heart rate and she was already pretty tachy.

Before she woke back up the tech (Jeff) and I put in a catheter so I could try to get a urine sample.  This would prove to be the most interesting part of the night.  Poor Jeff, I don’t think he’ll ever work with me again.  He handed me the scissors and I cut off her stretch pants.  As soon as I got half way up her leg Jeff pointed at the crotch of the pants and yelled “WHAT’S THAT??”  Her black pants were stained brown.  As soon as I got the pants cut off of her Jeff puked in his mouth and had to leave the room because of the smell.  I think I had been in the room for so long I was just used to it.  A couple of minutes later he came back with a bag full of coffee grounds for him to smell when needed.  I got everything set up and put on sterile gloves, I’m not sure what difference trying to be sterile made considering how dirty she was.  As soon as I was sterile I realized that I forgot to put the arm rail of the bed down and I couldn’t reach her well enough over it.  So, Jeff came around to put it down for me.  Small problem, her arm and large boob were in the way and he couldn’t hold them out of the way and put the railing down at the same time and I couldn’t touch anything to help.  Finally I was able to put my elbow against the arm rail to hold it while he moved her boob, the poor guy.  He was like “OHHHH, YOU OWE ME SO BIG!!!! Finally, I got her clean, not easy because she was full of yeast and all other kinds of stuff.  I can’t call it anything else but crotch rot.  Then for some reason he lifted up her belly to find even more yeast.  This girl needed some major anti fungal powder.

With in 10 minutes her pressures were around 100/40s.  She was awake and screaming every bad word in he book at her grandmother.  Her grandmother finally got up and walked out of the room.  We told her to go home, that she was going to be in the hospital for a long time and she didn’t need to sit and listen to that right now.

From then on her vital signs stayed pretty good.  Her pulse got pretty fast, so I had to slow the drip down.  She kept rolling over and getting tangled in all of the tubes and cables she was hooked to.  At one point she wanted me to turn her over.  I was like “I can’t pick you up, so if you want to turn over you’re going to have to do it yourself.”  Which she did.  Anyway, since she insisted on sleeping on her stomach we wouldn’t let her have a pillow, because we were afraid she would suffocate.  I think she had sleep apnea because every time she fell asleep her pulse ox would drop into the low 80’s despite her having oxygen on.  So, whenever she would wake up for a couple of minutes she would SCREAM for a pillow.  One time I happened to be in the room when she was doing this and tried to explain that if she would lay on her back she could have one, but not if she was on her stomach.  She informed me that Jesus would deal with me.  Because by me denying her a pillow I was denying my maker.  She sure liked to go back and forth from screaming obscenities and talking about Charlie’s willy to talking about Jesus and Heaven.  Oh, at least I had something to laugh about from the situation.