Tales from the ER: Meningococcemia

Tales from the ER: Meningococcemia


February 27, 2008

“Hey” the security guard was standing at the counter where I was charting. “There’s a lady outside who needs some help getting her husband out of the car.”

I got a wheelchair and followed him out front to the ambulance bay where a woman was standing next to a minivan literally wringing her hands and crying.

I went around to the passenger side of the vehicle. It has long been my belief that the people most in need of an ambulance usually come by private car and one look inside told me that this was one of those guys.

“Go inside and grab the first nurse you see and tell them to come out here with a gurney and some help.” While he was inside I asked the woman how long her husband had been like this. ‘This’ was obtunded. A good nurse can tell with one look when someone is really sick and ‘this’ was it. According to her, he had been ill yesterday with flu-like symptoms and was okay when he went to bed last night. He had awoken her this morning thrashing around in delirium.

We got him out of the car and onto the gurney. Truth be told, we manhandled him out of the car, he was dead weight. There is no good way to get someone out of the car that can’t help you. I still can’t imagine how his wife got him in the car. Through the pneumatic door and into the ‘crash’ room, yelling for a doctor, respiratory and xray. The patient was hot to the touch and moaning incomprehensibly. As we cut away his clothes we saw the petechial lesions on his arms and legs. Any good critical care nurse worth their salt will be able to identify Meningococcemia, and here it was right in front of us.

Initial BP was 69 systolic, HR was 167. Lines were started and fluid boluses given. The patient was quickly intubated and put on the ventilator to protect his airway. BP remained low so powerful vasopressors were started and the shock team was called. Two doctors and three nurses were running non-stop hanging drips, inserting lines, monitoring vitals in an intense effort to save his life.

Before long he was whisked off to the ICU, slightly more stable with a blood pressure of 88 systolic on high dose Levophed. I found out later that he did survive but had a 4 month long ICU stay and lost all of his toes. Surviving this deadly illness does not mean returning to your previous level of function or quality of life.

As deadly as this disease is, employee health didn’t want to treat the staff, stating the disease is only transmitted with close personal contact. Maybe so, but my peace of mind is worth the price of that one Cipro tab. Sheesh.

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