Monday, September 15, 2008

Hogan's Goat and a Soup Sammich

Hot and humid as hell Saturday morning. My partner went goose hunting (ugh) before coming to work and had a truck bed with 6 dead geese in it. He went out to pluck and cut them and I had the bright idea that geese have really long necks, so really long trachs for me to practice on. So while he plucked the feathers and cut the breasts out (yes, it was as nasty as it sounds, plus a couple dozen flies) while I get to their necks and practice crics over and over. I'm a pro now!

Finally we got a flight. Transfer from the city out to the mountains to another teaching hospital/trauma center. This guy showed up to the ER a few days ago with rectal bleeding...and oh, a tumor the size of a grapefruit in his tracheal/laryngeal area. We sort of got report, the ICU nurse says "I've never done this (transfer a patient?!?!) before." Never a good way to start. It sounded like he crumped out on a tele floor, gt transferred to the ICU and then to the OR to fiberoptically intbate and do a bronch. They got a tube with some difficulty and when they started to bronch he started bleeding like shit into his lungs and the sub-q space. When I first assessed his airway his tumor had deviated his trach like a goiter and (to quote my sister) his upper chest was "soggy." With all of the bleeding his pressure had begun to crap out and h was on neosynephrine for BP. (Ummm.... blood anyone?)

So we got packaged, on our stretcher and out the door without incident. We loaded onto the aircraft stretcher and were getting ready to secure the skid when the RRT reached forward to bag the patient (after being told not to) as we slid the skid forward. All of a sudden a difficult to bag patient became "really easy" (her words). That's because the ETT cuff is in the patient's FUCKING MOUTH! Yes, she extubated the patient. There was a serious butt pucker moment when the medic, who was in the airway seat, did laryngoscopy and couldn't see shit. We tried the bougie, and a styletted 7.0 tube without success. He started pouring blood out of his nose, which was EXACTLY what we needed right then! There was no way in hell that we were going to "goose cric" this motherfucker. It would have been like popping a HUGE zit.... blood everywhere. So we decided to go with our backup airway device.. a KING LTD. Success!!! I taped that tube like it was gonna escape (1001 uses anyone?) and we got the hell outta dodge.

No issues in flight, thank god! We debriefed with the clinical manager, ops manager, base supervisor and medical director when we got back. As well as the poor pilot who watched the whole situation with an "Oh shit" look on his face. We decided that on the Oh SHIT O'Meter that this was a 7/10. Described as fucked up as Hogan's Goat or a Soup Sammich.

We swung by the ER later that night to check things out.... it was a full moon after all! There was a guy who fell on a pair of scissors and had a radial artery bleeder. The doc was WAY out of his league trying to tie this thing off. We were just waiting for him to say "fly him." Poor guy had a pressure in the 70's, was anxious, diaphoretic and a little confused. He was the picture of hypovolemic shock. I'm sure the artery was still leaking when he closed the skin. He had a hematoma that continued to grow under the skin. I'm sure he was back the next day when that thing blew.

Drama Drama Drama..... and I get to work a princess in the ED tonight. The moon is still full! Can't wait!


Blogger GingerJar said... did the RT like drop outta sight and stay there! Sounds like it was fucked up beyound all reconition (you know your good old Texan FUBAR).

11:38 AM  

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