RN, BSN
As a registered nurse who has worked in the emergency room for the last several years, I know that Halloween can be a fun time to work. Most departments carve pumpkins and create amazing costumes, and there’s plenty of candy to eat. However, it also presents some unique patient care challenges and common injuries we see year after year. And as the night wears on, the more outrageous those trick-or-treatments become.
Along with candy bars and costumes come orthopedic injuries. With so many people walking outside at night in dimly lit areas, the emergency room (ER) will see its fair share of twisted and broken ankles and wrists on Halloween. In addition to ankle and wrist injuries, pediatric patients will present with all sorts of contusions and scrapes from running around in their sugar-fueled excitement. Their vision is often obstructed by masks, along with capes or long costumes, causing a huge increase in trips and falls.
If you’re a nurse caring for patients on Halloween, ensure you have plenty of ice packs ready and the ortho and suture carts are easily accessible. You’ll need it.
Although not as standard as orthopedic injuries, allergic reactions to costumes and face paint occur on Halloween. I cared for one patient with no previous latex allergy who presented to the ER with shortness of breath and airway disruption after wearing a latex mask most of the evening. He had red hives covering his face, neck, and chest and was wheezing loudly by the time he got to us. Fortunately, the IV Benadryl, Pepcid, and Solumedrol the doctor ordered quickly increased a patent airway.
That was an extreme case that could have gotten worse very quickly. However, many Halloween-related allergic reactions, especially pediatric cases, involve itching, hives, and discomfort from face paint, masks, and costumes. If caring for one of these patients, have your airway box easily accessible. Conditions can change quickly, especially in children. Monitor for any changes in breathing or swelling of the lips and tongue.
What fun is Halloween without spooky Jack-O’Lanterns adorning the neighborhood? Leading up to Halloween, emergency room visits for lacerations and puncture wounds to the hands increase dramatically. Many of the Halloween lacerations I’ve helped treat were due to the patient’s hands slipping on the knife during pumpkin carving. Many were serious injuries affecting surrounding arteries, veins, and tendons.
These injuries can be quite disturbing for the patient, like something out of a scary Halloween movie. Gauge their comfort level and create a barrier so the patient doesn’t look directly at the affected area. Immediately control any bleeding and clean the area if safe to do so. This allows the ER doctor to assess the severity of the injury quickly, determine treatment and consult ortho or plastic surgeons if necessary.
Emergency room staff are no strangers to patients who are under the influence of drugs and alcohol. Halloween partygoers who have over-ingested can unfortunately end up in the ER for the after-party. Sometimes, this results in an impromptu Halloween parade and costume contest in the waiting room, or the patient dressed up as a nurse wanting selfies with the actual nurses. It might also entail your patient yelling at the Jack-O-Lanterns at the nurse’s station, then telling them which one should’ve won the hospital-wide contest.
Monitoring these patients closely for respiratory distress and level of consciousness is imperative. Finding out what substance or substances were ingested will, of course, guide your nursing interventions. First and foremost, keep yourself safe if the patient is agitated or potentially violent. Alert nearby nurses if you have concerns, along with the security team if your hospital has one.
Working a shift in the ER on Halloween can be challenging, but it can also be fun and exciting — and at least there’s candy. Consider these takeaways to help prepare for a Halloween shift:
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