Thursday, May 22, 2008

Always, Always take someone with you to the Hospital ER!

Recently I had an interesting experience. I found myself going to the ER with an intense pain in my side and needing to have it checked immediately out of concern for a rupture that would lead to peritonitis. Granted if I had listened to my wife, I would have gone to my primary care physician more quickly, but I figure I pulled at least "a 1/2 guy, with some splash." While the triage could have been more effective once we arrived at the ER, I found myself playing good cop to my wife's bad cop - when we were trying to get my vitals taken. My wife was helpful in speaking up for me.

In this day of the health care field being under assault for rising costs and finding ways to make strategic cuts, modern ERs don't have the hustle and bustle that the NBC show, ER, tends to display. Duplicate equipment costs money, so they don't seem to have too many extra machines around - such as blood pressure machines. They aren't going to have as many staff on duty as once they might have - all in efforts to control costs I am sure. However, that means it is even more important that you have an advocate with you at the ER or hospital until you are lucid enough to watch and react for yourself.

My experience is telling of this. After we finally had my vitals checked, the ER found that I did have a strong need for immediate care. They put me on IV antibiotics, morphine for the pain, and otherwise started diagnosing and treating me. I found that the ER nurse would come in with the a machine to check my blood pressure, and then take it with her to check someone else in another room. I seemed to have been stabilized, was propped up on a gurney without a cuff or call button on me, and was waiting to allow the contrast to absorb in my digestive system for an hour before they could take the CT scan. No one was immediately around except my wife. After 40 minutes, I had been doing decently well when quickly I started feeling first more tired, then nauseous, then really nauseous, ... then the sense that my skin was on fire, started sweating profusely, and feeling far worse than I have EVER felt in a matter of moments. At the beginning of this, my wife ran to get the nurse quickly. This was all going on as they run back into the room.

When the nurse came in, her first concern was that I was having an allergic reaction to the antibiotic, which was not unreasonable given my medical history. They flattened me out on the gurney and put the blood pressure cuff on me; I was still feeling really bad. My wife, though, quickly suggested to further raise my feet even higher while they were cuffing me to check my blood pressure. Right before my feet were elevated, I had dropped from about 148/95 to 71/50 - which they called a "vagal." I quickly started feeling better once my feet were up. It was then that the nurse indicated the danger of such dramatically falling blood pressure - kidney failure, followed by other organ failures, and then death.

If my wife had not been there, I would not have had someone to run and get help quickly, and independently be assessing the situation. Given the position I was in - propped up in the gurney - if I had passed out without anyone there, I easily could have been found after 10-20 minutes or so - which could have been fatal. At a minimum, my wife probably saved my kidneys, and potentially my life by being there - getting help and assessing the situation as well. Part of connecting with people is making sure you know enough people to ask to go with you to the ER. For those with amble family nearby, they will serve. If you are someone without a lot of family nearby, then definitely start having those conversation with close friends and agree to be there for each other.

While I am sure the lawyers who read this will be assessing blame, it is MUCH easier to avoid the problems or deal with them quickly before the consequences occur - than judge people for years afterwards. For me, I am doing better after spending several days in the hospital. There luckily was no rupture and I am slowly on the mend.


At the time of this incident, as I reported above, the term the hospital used with me was "Vagal." Sometime after that, a friend who is a physician first used the phrase, "you might have been a little septic" when he heard the story. At the time, the term "sepsis" was not in my vocabulary and it went right past me.

However, several months later in January 2009, a Brazilian model died suddenly in an ER in Brazil when she presented with what they thought was simply a urinary tract infection that was severe. Within days, she went into "septic shock," lost consciousness and never regained it. In the days that followed, because of sepsis, she developed gangriene set in and they had to amputate her hands and feet to try to save her life. They did not and she died a few days later. I began to look into this incident since it had a lot of similarities on the front end to my experience, and made me very appreciative that my outcome was different.

The concern about sepsis, septic shock, and any other "true" shock became very real to me. I believe based upon my vitals I likely was on the beginning part of septic shock when I had a "vagal" and I was fortunate not to go into full blown sepsis. When these occur, a cascading organ failure can start that is difficult to stop - leading to hypotension, loss of consciousness, kidney and liver failure, brain damage and DIC, followed soon after by death. I was on IV antibiotics, fluids and morphine for 40 minutes at the time and I had pretty fast care when I went into shock, thus ensuring that I did not suffer oxygen deprivation to the brain or other organ failure.

If you do not fully understand the nature of "sepsis," and want to know what to look out for, please consider watching this video by the Sepsis Alliance, a non-profit educating people about this danger. If you go into an emergency room with the possibility of a severe infection, consider expressing "I am concerned about sepsis," and if they don't seem to know what that is, find someone there who does.

Similar concerns also exist for other true shock conditions, whether it originates as septic (vasogenic), anaphylactic, or hemorrhagic (cardiogenic, hypovolemic, or neurogenic) shock.
See also,

1 comment:

Tom Magness said...

Great advice. Hooah for Heather! I'm glad you are doing better, my friend. TM