Breaking the Sound Barrier (to Action)
experienced emergency workers upon opening the door to the department, can
'read' or sense the activity within seconds just by application of the senses.
One that seems obvious is the hearing of sounds, yet there are unusual aspects
to the interpretation of those sounds, and some less common.
healthy cry of a newborn baby is considered a happy sound.
airways and wet or wheezy lungs are famed for characteristic sounds unto the
"death rattle" and "last gasp."
epileptic seizures will be heralded by a loud inspiratory "cri du epilepsie"
as the diaphragm contracts in spasm and by the strong negative pressure against
a partially closed larynx (in the form of a Müller maneuver or "reverse
Valsalva maneuver") similar to that made by a partially-obstructing laryngospasm.
and dislocations that are being reduced can produce a snap or click as the
parts mesh again.
the electrocautery pen can induce a little sizzle as it cauterizes or as it
perforates a nail with a subungual hematoma.
listens for the hissing sound of a tension pneumothorax as the pressure is
relieved by thoracotomy.
emphysema (air trapped under the skin) can produce a "Rice Krispies®”
sound of "Snap, Crackle, & Pop®” when palpated.
are sounds that we don't
want to hear: the plangent wailing of a family in anguish and grief at a death;
the wild cries and threats of a violent agitated patient, or worse, a hostage
situation; the dead quiet despondency when a child has succumbed.
sound of crashing stainless steel or enamel bedpans and urinals is generally
obsolete, having been replaced by plastic. There goes the chance to test for a
would rather hear the happy and efficient hum of a department that is running
well, for the moment, and patients are doing OK, and are satisfied. Better yet,
is the relaxed and happy laughter of a staff "food night" that things
are under control and everyone is gleefully under-utilized.
sounds will 'galvanize' (in the original electro-galvanic sense, not the
weatherproofed hardware) experienced staff into instant activity. —The large
heavy thump on the floor. It has a peculiar 'deadfall hammer' aspect to it:
that is say it is like the mechanic's tool designed to provide a heavy impact without rebounding. A
thud that doesn't bounce. This is the fall of a body to the floor, either from
falling from bed or someone with sudden unconsciousness or death, unable to
mitigate the impact. Sometimes, it is accompanied by a crunching and crepitant
sound of facial or cranial bones shattering. Staff will respond faster than a Superhero.
A slightly hesitant response to the sound discerns those who have not heard it
or imagined it. No good can come of this sound, and it will surely mean extra
reporting. A surviving victim would likely call out or express their pain or
attempt to rise.
the oddest sound is when a patient has died and is being removed from the department,
and the bed hits a bump at a doorsill or a join between buildings. The
concussion causes residual air in the lungs to be expelled with an audible
grunt or moan 'from the dead.' This can greatly surprise someone who is not
aware of the phenomenon.
Tom Trimble, RN
All opinions are solely those of the author.
Readers must verify validity to their own practice.