1 Emergency Department North West Regional Hospital, Burnie, TAS, 7320 | RN Grad Dip (Emergency Nursing) Grad Cert (CritCare, Rural and Remote Health) Certified Instructor (Non-violent Crisis Intervention) BN
Historically, international travel was the privilege of the wealthy, but the advent of discounted airfares in recent times has brought overseas travel within the reach of the average Australian. Although intrinsically remote with great distances between localities, our country is also extrinsically remote in its isolation from other countries. Consequently, a nurse may find his/herself practising in challenging and/or remote situations, with scant support. The following talk is a personal account of my experience of practicing in a very confronting environment during a mid-flight emergency. The presentation is underpinned by research on remote nursing and obstetric emergencies and summarised with my reflections, experiential learning and recommendations.
Halfway home from a family holiday to Fiji I had just put my book down and closed my eyes, when a man in the opposite row called for help. His wife – Sophie*- was lying awkwardly across the seats and floor in the clonic phase of a seizure. Given her obvious state of pregnancy, I immediately suspected eclampsia, an obstetric emergency. Practising my DRABC I noted she was in imminent danger from surrounding fixed structures and at risk of positional asphyxia, so her husband assisted me to re-position her as the call went out for a “doctor on board”.
Her unresponsive post-ictal state indicated a GCS of 5 at best (E1V3M1) causing me further concern over the patency of her airway, so I enlisted the help of two men, who identified themselves an obstetrician and a urologist, to carry Sophie to the galley. I turned to resume my seat, but when they discovered I was a remote emergency nurse, I was asked to stay, primarily because neither had cannulated for over ten years!
While conducting Sophie’s secondary survey, we discovered that she had many risk factors for pre-eclampsia, including having the condition in a previous pregnancy and hypertension during this pregnancy. At this point, my talk will detail Sophie’s management, including intravenous drug therapy, fluid resuscitation and airway management.
Most emergency nurses will find ourselves, at some point, practicing in challenging and/or remote situations. However, I confess being 30000ft above the Pacific Ocean with a severely hypertensive post-ictal woman and limited medical supplies the most isolated and challenging situation of my career. Not to mention the almost surreal experience of sitting on the galley floor, managing the patient’s airway while the plane landed!
Upon reflection, I learned much from this unusual experience. Firstly, I was reassured that I was equipped to deal with a highly challenging situation. Secondly, it reminded me of how resourceful one becomes when working in remote areas and the intestinal fortitude one develops. It also made me realise that a good nurse is never off duty; we can leave the problems behind at the end of a shift, but we never leave the caring shut up in our locker. Finally, it reinforced my personal belief that all nursing students should experience remote placement time as part of the Bachelor of Nursing degree.
Australian Resuscitation Council http://resus.org.au/guidelines/flowcharts-3/ accessed 14/7/16
Central Australian Rural Practitioners Association, 2009, CARPA Stamdard Treatment Manual 5th Ed, Alice Springs, Central Australian Rural Practitioners Association
Curtis, K & Ramsden, C 2015, Emergency and trauma care : For nurses and paramedics, Chatswood, NSW : Elsevier Australia, 2016. 2e Australia and New Zealand edition.
Duley, Lelia. “Pre-eclampsia and the hypertensive disorders of pregnancy.” British Medical Bulletin 67.1 (2003): 161-176
Duckitt, K. and Harrington, D., 2005. Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. Bmj, 330(7491), p.565.
Smith, JD 2007, Australia’s rural and remote health : A social justice perspective, Croydon, Vic. : Tertiary Press, 2007. 2nd ed.
Karen has a varied background over the past 35 years, beginning her nursing career as a mental health nurse under the “old system” in the early 1980s. She returned to study at the University of Canberra in 2000, to complete a Bachelor of Nursing. She has worked in the emergency department for over seven years after extended stints in remote health and ICU nursing. She has also practised in women’s health, general practice and drug and alcohol programs. Karen has recently diversified into teaching as a certified instructor in non-violent crisis intervention and works as a sessional teacher of the Diploma of Nursing at TasTAFE. Her other qualifications include Grad Certs in both Critical Care and Rural and Remote Health, as well as a Grad Dip in Emergency Nursing and expects to complete her Masters of Clinical Nursing degree in October 2016. Karen’s clinical interests are education, crisis intervention and an intense fascination with the pathophysiology of trauma, particularly brain injury. Her personal interests include a passion for travel and study of languages, animal welfare, playing netball, volleyball and softball, loud rock music and maintaining an organic mini-farm. Not least, she enjoys spending time with her family and spoiling her four grandchildren, and her greatest supporter through all her academic achievements is her husband David.