WhiteCoat

Unconventional Sign Language

Shaka Brah Gesture_raised_fist_with_thumb_and_pinky_liftedThe patient coming through the door was having trouble breathing. No doubt. You could hear the hiss of the nebulizer as the cart whisked by the nurse’s station into a room.

Most people knew the patient from prior emergency department visits.
Bad asthma
Steroid dependent
Several previous intubations
Last ED visit a couple of months ago

Unfortunately, being in the middle of doing a central line on a septic octagenarian with a systolic blood pressure less than her age makes it difficult to go evaluate a new patient.
I asked the nurse to go get me one of the PAs.
“Do me a favor,” I said to the PA, “Go take a peek at the new patient and see how she’s doing.”

After a minute, the PA came back and said “Everything looks pretty good. She’s trying to get comfortable on the cart right now. Her lungs have a few wheezes but are pretty clear. Her saturation is 100%. She even gave me the ‘Chaka Brah‘ sign.”

Good. Now I can finish getting this line in place.

A few minutes later, there was a commotion from down the hall.
“We need a doctor in Room 3 NOW!”
Room 3? That’s the asthma patient’s room. I looked at the PA. She looked back at me with horror.
“Just hold the dressing on this line until I come back and sew it in place, OK? Thanks.”

In Room 3, the asthma patient was diaphoretic and was moving very little air. She was tripoding. She gave me one look and did the “Chaka Brah” sign at me, too — pretending like her fingers were like an endotracheal tube and repeatedly poking her thumb at her lips through her nebulizer mask.
Then she started slapping the side of the bed and shaking her head.

Dammit.
We need to move fast.

“We’ve got you. We’ve got you. We’ll have the tube in in a couple of minutes. Just hang on.”
The patient spun her index finger in quick circles.
I know. I’m hurrying. Fortunately the paramedics had a line. Oxygen.
Crash cart. Ketamine. Sux. Tube in. Start the propofol.
Lung sounds bilateral but diminished. She’s not moving a lot of air. That’s why her wheezes were so faint.
Steroids and in-line nebs.
Sats good.
“Relax, kiddo. You’ll be better with the medications. We’ll keep a close eye on you.”

[Exhale]

Back to the octagenarian to do some quick suturing and some quick didactics in asthma, respiratory distress … and how to interpret unconventional sign language.

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This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me.

7 Responses to “Unconventional Sign Language”

  1. girlvet says:

    And thats why PAs don’t belong in the ER.

    • WhiteCoat says:

      Buttoning my lip, donning tin foil hat, and making some popcorn now.
      This should get interesting. :-)

    • CamPA-C says:

      Booooo! Just like with any profession, you’ll find both good PA’s, docs, and nurses and bad PA’s, docs, and nurses. I hope you work with a great PA someday who will change your mindset.

  2. Teresa says:

    How could her saturation be 100% if she is moving very little air? I’m curious.

  3. Christine says:

    Teresa, I’m a little confused at this too. However, I will say this. Young people will not drop their sats for awhile. They have reserves, often. I’ve personally experienced this with my asthma attacks. I’ll be 98% for awhile, then suddenly drop to 80%.

  4. MS4 says:

    Ketamine? Why not RSI?

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