Where Angels Tread
Michelle Standing Cloud didn’t see the rattlesnake that would bring her to death’s door on that hot summer day in June 2010, nor did she feel the bite. She had one thing on her mind as she bounded from her uncle’s home, down the front steps and onto the gravel — getting back to the swimming hole as fast as she could!
But lying in her direct path was a Prairie Rattlesnake, the only poisonous snake in the state of South Dakota. Michelle’s eyes brim with tears as she tells about the fear she felt when her foot came down and she realized she had stepped on a snake.
At once she ran for protection to a nearby car. Her shrieks of panic brought her friends from the house. One killed the snake with a shovel, and the other friend, Loretta, rushed to her side to comfort her. That’s when Loretta said, “You are bleeding,” and Michelle saw the telltale triangular bite on her ankle.
“Within moments it felt like razor blades were cutting up my leg,” Michelle relates. This sensation was followed almost immediately by difficulty breathing. “I felt like I was fading,” she says.
Her friends acted quickly, calling ahead to Wagner Community Memorial Hospital Avera in Wagner, S.D., to inform the Emergency Department that they were bringing in a snakebite victim. During the 30-minute car ride, her friends administered rescue breathing to Michelle. At the hospital, Robert Hubley, DO, was called in, and antivenin to counteract the snakebite was readied.
On arrival at the hospital’s emergency bay, Michelle was in and out of consciousness, unable to move on her own and incoherent. She remembers practically nothing other than looking up at “two angels with lights behind them” and saying, “Save me.” One of the two angels was Mark VanRavenswaay, RN, who provides much of the story that Michelle cannot recount.
“Miraculously, Michelle’s arrival coincided with shift change, which meant extra staff on hand to handle all that happened next,” Mark explains. “One nurse interviewed the family. Another brought in Avera’s eEmergency care team.” Mark, aided by a certified nursing assistant, administered rescue breathing, while Dr. Hubley and other nurses started an IV, monitored vital signs and administered dopamine to bolster Michelle’s dropping blood pressure.
Consulting with Brian Skow, MD, via eEmergency technology, the care team determined it would be necessary to administer the antivenin, a calculated risk because the horse-blood base in the serum causes allergic reactions in a number of patients.
Within minutes, Michelle’s lips and mouth began to swell dramatically, as did her airways. Her heart went into a lethal rhythm called ventricular tachycardia. Medications were administered to counteract the antivenin, and the care team continued to monitor vital signs, provide fluids, administer rescue breathing and respond to Michelle’s dangerous and constantly changing condition.
“When eEmergency was contacted, nurses at the hub began charting, which freed up our hands for direct patient care,” relates Mark. The eEmergency team was another set of eyes on Michelle’s situation, providing support to the local care team and collaborating on next steps.
“We call them our angels,” explains Ilene Jansen, RN, director of Nursing in Wagner, “because they literally look down from that monitor on what we are doing and help us.”
On this day, the eEmergency team also dispatched the CareFlight helicopter team, which arrived to assist. Laboratory results helped the combined local, long-distance and CareFlight team to determine that it was best to continue administration of the antivenin with counteracting medications.
Shortly it became clear that Michelle needed oral intubation in order to open her airway and prepare her for transport. The swelling was making it impossible to maintain breathing. That same swelling also made intubation impossible, and Ahmed Dessouki, MD, was called to perform a tracheotomy. The CareFlight team then put Michelle on the on-flight ventilator and rushed her to further emergency care at Avera McKennan Hospital & University Health Center in Sioux Falls, S.D.
Two weeks later, when a smiling Michelle approached Mark in the hospital hallway in Wagner, S.D., he didn’t recognize her until she showed him the scar left by the tracheotomy. “I didn’t think I would see her up and walking around so soon, and I had never seen her without the swelling. I was amazed it was her,” he says.
Michelle returned to thank Mark, one of the angels she last remembered seeing. The visit provided the opportunity to explain the eEmergency service used in Michelle’s care to her and to introduce her to the “angels” on the other end.