Shelly Samuel, LPN, was assigned to nursing duties at the Lafayette Parish Correctional Center which is the adult detention center of the Lafayette Parish Sheriff's Office. At approximately 17:30 Nurse Samuel was exiting the building after completion of her shift and overheard a Signal 36 code (Code Blue) called over the facility intercom. Even though she was technically off duty, Nurse Shelly recognized that the 2 LPNs in the medical department when she left were relatively new to the corrections environment and nursing in general. She immediately re-entered the building/department and went with the nurses and security deputies to the code. Upon arrival, the nurses found an unresponsive male patient lying in his cell. A strong smell of smoke was apparent in the housing unit and the staff visualized a small amount of what appeared to be a drug type substance by the patient. Initial assessment showed vital signs relatively stable, however, respirations were shallow and rapid with decreasing oxygen saturation. The patient's pupils were pinpoint and fixed without accommodation. The patient was unresponsive to physical or tactile stimuli. Nurse Shelly immediately informed the security supervisors to have emergency EMS en route to the facility. She applied oxygen via a re-breather mask and administered Narcan (Naloxone) 0.4mg/ml intramuscularly to the deltoid. Vitals signs continued to diminish to undetectable on the electronic vital sign machine including oxygen saturation decreasing to 30% until approximately 1 minute after Narcan administration. At this point, vital signs began to register, and oxygen saturation steadily improved to 45%, then 60% and finally when EMS arrived, oxygen saturation was 96% and the patient was removed from supplemental oxygen and remained stable on room air.
During this time, Nurse Samuel recognized this was one of the first emergent events for the 2 (new) LPNs working, as well as several of the responding security deputies. While implementing an emergent care plan she explained to staff members how to utilize certain equipment such as proper administration of supplemental oxygen and how to apply appropriate pressure for a sternal rub. She also demonstrated an appropriate mouth swipe to remove hard candy from the patient’s mouth. By the time emergency personnel arrived at the facility the patient was semi-coherent, however, he was markedly improved from 20 minutes prior. Her actions were applauded by emergency personnel who arrived and transported the patient to a local emergency department for further evaluation and treatment. Nurse Samuel managed the emergent event with a calm demeanor, accurate critical thinking, and quick and confident decision making. If not for her actions, the patient’s outcome would very likely have been much different. The patient has been afforded a new chance and hopefully a more humbled outlook on his actions.