The urgent phone call came at 5:15 a.m., just as nurses in the Post-Anesthesia Care Unit (PACU) were wrapping up the night shift, routinely preparing their BWH unit for the day of surgeries ahead. They were about to become the center of a life-or-death crisis, spawning an extraordinary team response.
“I was with a patient who just had a CT scan,” said Chris Shinnamon, RN, a float nurse. “We needed a bed immediately, and none was available in the Neurosurgery ICU.” He had worked in the PACU before, so he knew beds often were open there in the early morning, before patients begin to arrive for surgery.
Moments later, the patient was wheeled into the PACU. The nurse in charge, Karen Munkley, RN, BSN, MS, quickly realized the situation was critical. A 34-year-old man was barely conscious and desperately struggling to breathe.
Two days beforehand, he had undergone surgery for a brain tumor, and was doing well enough to be transferred from the Neurosurgery ICU to the general surgery floor. But during the night, Krimhild Dupont, RN noticed a sharp change in his condition and increased agitation. She called the neurosurgical resident, who ordered a stat CT scan. It showed hydrocephalus, and the fluid collecting near the brain was reaching a critical level.
“The patient had 10 to 15 minutes to live before the brain herniated,” said Munkley. “Drainage to relieve intracranial pressure needed to be done immediately. There was no time to spare.”
The neurosurgical resident, Jonathan Slotkin, MD, who had accompanied the patient to the PACU with Shinnamon, was ready to perform the procedure. But the necessary equipment needed to be gathered from other parts of the hospital. Munkley placed an urgent call to the Neurosurgery ICU on Tower 9. Lisa Sowydra, RN immediately ran down to the PACU on L1 with the neurosurgical supplies used to drain cranial fluid.
The team also needed a portable cauterization unit, used to singe blood vessels to prevent hemorrhage. Munkley called the Emergency Department, which rushed that apparatus to the PACU. With proper equipment now in hand, the fluid was drained. “Within 5 minutes, the patient was coherent and talking to us,” she said. “The crisis had passed.”
Munkley noted that many dynamics contributed to this hospital-wide team effort. “At night, BWH is a smaller world,” she said. “We know each other well and know who to call.”
Other key factors were the clinical staff’s fast thinking, flexibility and spontaneity. “A young man is alive today, thanks to people who rushed resources from all corners of the hospital to our unit,” said Munkley. “The fact that the PACU is not the standard place for such procedures didn’t matter. Everyone simply pitched in to save a life.”