Atropine, anyone? Anyone?

The above was an actual quote from the other night.

The whole day was not terrible. It could have been better, but it definitely could have been worse.

And then at about 11:15 pm, just before I was supposed to go home, the entire ER exploded. Ok, not LITERALLY. But we got five or six ambulances at once, two notifications, and one patient was about to be intubated. AND one of our nurses who is about 5 months pregnant had to go upstairs to L&D because she was having very strong contractions. I was running around trying to help out as best I could.

I was asking one of my coworkers if I could help her with anything, when one of the upstairs residents came over, and nonchalantly said, "Do you have any atropine around, or something?"

I stared at him and said, "For who? Is someone coding in here?"

He lazily scratched his head and said, "Uh, we just brought a stroke code down from upstairs for a CT scan, and I think she's bradying down."

"What?!" I grabbed a couple of amps of atropine and ran over to the CT scan room. Four people were standing around this little old lady who was schlumped over in a stretcher, breathing like people do who have had a stroke and have slack facial muscles (think curtains blowing in the wind). Someone is mumbling, "I think she doesn't have a pulse. She might have died in the elevator..." No green band on her wrist, so she's a full code. Heart rate on the portable monitor is 27. Looks like sinus rhythm, but the monitor she's on is some ancient piece of crap and who knows if that's reliable.

"Uh, has anyone checked a PULSE?!?" I grab a wrist and put the other hand on her femoral artery. The CT tech, a transporter, some lady in a white coat, and the doc who grabbed me outside are standing there staring at me. Tiny, thready pulse. "Is she on oxygen? Get a non-rebreather! These nasal cannula are doing nothing! Doc, do you want this atropine in? Doc? How's about point-five of atropine? HELLO?!?" They all stare at me. "IS there a CODE CART IN HERE?!?" They roll over some freaking ANCIENT monophasic monster. It had so much dust on it it was furry. It was yellow--like those old waterproof Sony Walkmans. I could not even figure out how to turn it on.

"Atropine anyone? Anyone?" Oh, fuck this, I think, and give her the 0.5 mgs of atropine. (Point five if you're alive! Yay ACLS class!) They are all surrounding me like I'm an astronaut on Mars and they're aliens. Pulse comes up to 56. OK, not great but not bad.

"How's her airway? Anyone check for a gag reflex? do we need to intubate her? Has she had the scan yet? Is this suspected hemorrhagic stroke?" As I'm saying this, I'm putting a finger in her mouth to see if she gags and she bites me. OK, at least she's protecting her airway.

Then two of the ER residents come running in, one with the intubation box. The nurse I was with when the doc grabbed me figured something was up and notified our residents. I told them what was going on and they assessed the situation and agreed with me that she didn't need to be intubated, but needed to be scanned as soon as possible.

I turned to the woman in the white coat and said, "Are you this patient's nurse?" No, she was from STAFF ED. Just helpin' out! I asked her to please endorse to the covering nurse that I had given 0.5 mg of atropine.

And then I went home. Gack.