She’s In Fib! CHARGE 360…ALL CLEAR? (Part One)

The run had started like so many others. The beeping of the pager breaking through a listless sleep. A half awake glance at the cursed device showed the numbers for dispatch. The call was brief and too the point. Where?...... How Old……?, Okay Ill be in. Quietly dressing so as to not awake the wife I made my way in to the hospital. In a hospital 90 miles away a teenager was in trouble. A call to the hospital revealed her plight. She had consumed a large quantity of alcohol and was comatose. A CT scan had revealed the initial signs of brain swelling and the teen was unresponsive. Repeated attempt to place a breathing tube had failed. Grabbed my equipment and raced to the helipad. The flight nurses were already there and the copter was warmed up and ready to go. We raced through the mandatory FAA briefing and boarded. The turbines on the BK-117 spun up and we lifted off the pad. We hovered briefly to make sure the mechanics were sound than the ship pitched foreword and we were off. As we flew through the early morning darkness, my thoughts raced through scenarios and the all important game plan. As always, in the back of my mind was the thought that this may be the one transport that I am unable to handle. The miles pass nervously as I focus on the task of briefing my team. As we approach we get the message we do not want to hear, the patient has grown unstable in the time we took getting there and now is in full arrest. Landing on the pad, we are met by security. Leaving the security guard and the pilot to get our equipment into the emergency room we race towards the lit doors. It is readily apparent where we should head. The bedside that has 30 people around. There are screams for equipment, screams for drugs, screams to get a social worker. Time seems to crawls to a stop and everything seems to be in slow motion as we approach the bedside: The time is now 0317.

I introduce myself and the rest of the team. The first question out of the doctors mouth is “where is your doctor” to which I reply “we do not take one” Sensing his discomfort I give him a brief synopsis of our skills and capabilities. He seems dubious but remains quiet. As we survey the scene the 15 year old lying naked with a urinary catheter in place several IV’s running a variety of fluid, and a nurse who is doing compressions to replace the circulations from what looks like to be a heart in ventricular fribulation. A small blood piece of gauze drifts off the gurney and lands right in front of my foot.

The time is now about 0321 Staring at it for a second, I am seized with the thought that this may indeed be my nightmare. The call of my assistant startles me. He is asking about drug doses. Forcing myself back to the code I calmly reply give her 7 cc of 1:1000 epinephrine. I move to the head of the bed and call out what I need. My assistant, an nurse from our PICU pulls a 6.5 Cuffed endotracheal tube and a Macintosh curved laryngoscope blade. They have not been able to secure her airway and her oxygen saturations are drifting to well below 60 percent (94-100 is normal)

The time is now 0324 I order fentanyl, versed and Etomidate to be given sequentially. Called Rapid sequence induction it essential drugs and temporary paralyzes the patient so that they do not fight nor do they vomit in theory. The drugs are given and I gingerly attempt to place the blade so that I can visualize the vocal cords. Once spotted, I can pass the tubes through her cords and we can ensure she gets all the oxygen and carbon dioxide removal she needs. The back of the throat is littered with blood and vomit from the previous attempt. As I pass the blade is becomes clear this will be no easy intubation. As I call for crychotyroid pressure (pressure on the Adams apple) to force the airway down, the patient vomits filling the tube and flowing out her mouth with great force, as I turn her head to suction I note her lips are turning blue and her saturations are now down to the 40’s. If we do not secure her airway soon all will be in vain…………..

The time is now 0331

[edit on 3/1/05 by FredT]

Good story I can't wait for part 2 keep it up.