Tuesday, September 29, 2009

excitement, a little too much!

Yikes. This whole weekend has been pretty uneventful- lots of flu, actually, dare I say it, slow? Until... Sunday night. We got our payback, cause shit hit the fan.
I had a lot going on the whole night- a septic nursing home patient, full abdominal pain workup, and a chest pain who I was trying to get upstairs at the same time, but stuff I knew how to do- just a lot of it until later that night. I'm finally hitting a lull and getting rid of some people when they wheel back a lady with her foot up in the air and her sister walking next to her, carrying a bag.
She's been bit by a snake, they don't know what kind. Her vitals are stable, so I hook her up to the monitor and start and IV. My manager and I open the bag and pick up this snake trying to figure out what it is. The doctor comes in and looks with us- we don't recognize the markings, but it has a diamond shaped head. Uh oh, this is bad news. Poisonous. Our charge nurse wanders by and takes one look at it- Copperhead. Balls.
I call poison control and the doctor orders Crofab- an antivenom, apparently- they send it up in powdered vials with mixing instructions. My manager and I try to mix it and it's seriously insane- mix each vial with sterile water and then mix that in 250 ml of saline? Each vial? All of them? We don't know. I call the pharmacist, who tells me to send it back, so they can mix it. Thank you.
I end up waiting about an hour for the Crofab- while I'm waiting, they try to bring an wheelchair back to another room, that isn't clean- mine is, so I end up with a patient with chest pain and ST elevation on his EKG, which means acute heart attack, fly them the hell out to a cath lab emergency. Yikes. We repeat EKGs, start IVs- I explain to the family it may not be what it looks like and the doctor needs to interpret the EKG himself. We get meds at about the same time I get the Crofab- I give both and we repeat the EKG after I give the nitroglycerin, we show it to the doctor, and he confirms it- yup, ST elevation MI. We rush around working on transfers, starting a second IV- meanwhile I'm watching the snakebite lady like a hawk to make sure she doesn't have an anaphylactic reaction to the Crobfab. we get the transfer in order and fly the patient out, and with the Crofab going and my patient's vitals stable, I'm finally feeling at ease. I ended up having her the whole night, since we had no ICU beds, and she did great- we had cold compresses on her foot, so the swelling actually went down remarkably and she was looking great.
Luckily we had lots of EMS students there- not only were they able to help out with vitals and EKGs, but they also got to see some real stuff. It's always stressful at the time, but I love it now- I'm now the resident ER expert on snakebites, as I'm the first person to have dealt with one and given Crofab! Plus, I had lots of fun chasing the other girls on my team around with that dead snake.


  1. Yeah, Crofab takes forever to dissolve into solution and needs to be constantly swirled, not shaken. Be gentle with the pharmacists, they can't make it dissolve any faster.

  2. Yeah, they said it was super foamy. I'm really glad I didn't try to mix it by myself, I would have screwed that up royally. Our pharmacists are generally pretty bomb, so I try to be very kind. The doctors on the other hand, tend to be a different story.

  3. Once I was sent up to ICU to clean up a dead patient post snake bite that didn't make it. Horrible sight. Floating sucks. Anyway....the kid shouldn't have mixed alcohol with playing with snakes........never mind he tried to treat himself at home for hours before coming to ER....another bad decision.