You are working on a hot summer day in an advanced life support (ALS) unit. You are two days away from a month off. Your plan is to disappear for a month from all pagers and radios and will ensure no one orders you back to work until you’re ready.
You are called to the local hospital by a frantic 9-1-1 call. It is not normal for the nurses to be in trouble. It is a small hospital with a physician who is away today at the neighbouring community running a walk-in medical clinic. You commonly have coffee with the nurses and you know they have limited staff and if they are calling for help there is a good reason. Your partner “Mary” is a PCP and this is her first week at work; she is already nervous.
On arrival you are hustled into a patient’s room where a nurse is doing chest compression on what looks to be an older child. The nurse apparently had administered fentanyl IV as well as Maxeran IV after a post-op procedure and came back in 20 minutes to find the child unresponsive and pulseless. She had an open appendectomy for a ruptured appendicitis earlier today and was sent back to her home community to recover. Post-operatively she was slow to wake up, vomited a few times in the recovery room, but the post-surgery was uneventful otherwise.
Your partner runs to the airway. She appears to not be breathing. The patient is blue, pale looking, unresponsive and not responding to any stimuli. You immediately assess the patient and initiate lifesaving interventions and pray that time is on your side. This child, the mother of the child, as well as the nurse, need you more than you needed that holiday.
SAMPLE Hx (Emily 13 y/o female)
S – Sign/symptoms of either a respiratory or cardiac arrest for an unknown reason
A – No known allergies
M – Fentanyl 25 mcg, slow IV and Maxeran 5 mg, slow IV about 20 minutes ago, Ativan 0.5 mg IV just prior to surgery. There was a general anesthetic, A/B therapy was started and will be ongoing for three to five days. Immunizations are up-to-date.
P – NPO since yesterday, had tonsillectomy and adenoidectomy (T/A Surgery) at the age of three, with no other history or medical events.
E – Had an emergency surgery after having a ruptured appendectomy early this morning.
EMR – PCP (BLS Questions)