Emergency Trach

Today was an OR day. I love the OR. Today I had a very interesting experience. The most stressful / exciting to date in my training. We had another Polish patient with suspected advanced esophageal cancer with metastasis. Today all we were going to do was to biopsy the tumor in his esophagus to get an actual diagnosis of his cancer. This was to be an out patient procedure, in and out. The patient was intubated in the OR and we took a couple of pieces of the tumor to send to pathology. We then proceeded to wake the patient up. At this point my chief resident and 2nd year resident left to a consult in the ER. The attending physician was rounding on some of our other patients. The anesthesia attending had stepped out as well as this case was considered very straight forward. In the OR it was me, my 4th year resident, and the 2nd year anesthesia resident and a junior scrub nurse.

We excubate the patient and were preparing to transport him to recovery. He is breathing on his own and doing fairly well. He had some stridor but this was to be expected. Suddenly we notice his stridor stops and all airway noise ceases. Then all of his numbers start to drop. He starts to decompensate. This is where adrenaline takes over. My 4th year resident decides to do run an emergent tracheotomy. As the patient continues to crash, the thought crossed my mind; "holy sh%&^" we are going to lose this guy. Your brain can't survive very long with anoxia. The anesthesia resident was busy running his anesthesia and monitoring the patient and changing settings and pushing drugs to help. The junior scrub nurse was useless and scared. My resident yelled "11 blade" as the scrub nurse just stood there panicked I pushed past her and grabbed the 11 blade scalpel. The resident palpated for proper placement between the thyroid and cricoid cartilage and began to make an incision. I started to cut the tissue straps out of the way to expose the trachea. We lacerated a vein and blood was spilling everywhere to add to the excitement. As I listened to the resident instruction we exposed the trachea and made a laceration in the trachea. Meanwhile the scrub nurse was supposed to be preparing the tracheal tube for insertion but she was literally frozen so when the resident asked for the device it was nowhere to be found which put us in a tight spot as we had already cut into the trachea and I had my finger in the trachea to keep it from moving and to block blood from pouring into it and causing the patient to aspirate. The resident had my grab a suction tube and he cut it and inserted it to my finger and I pushed the tube into the trachea. 

At this point we all anxiously turn to the monitors to see if the patients O2 saturation starts to rise. It will usually take a few moments to start rising once the airway has been cleared. Those few moments felt like hours. Even though the monitors were screaming out alarm calls because all of the patients numbers were at critical levels but for those moments it felt as though everything was silent. I noticed the patient's chest rise and looked to the monitor to see his O2 saturation start to climb. We all let out a huge sigh of relief and slapped some high fives. The floor had blood spilled everywhere and my resident and myself were also covered with blood and sweat but no tears.

I sat there with my resident following the explosion of excitement and it all seemed so surreal. I was thinking to myself; "did this really just happen?" did I really have my finger jammed into this guy's trachea?" It was amazing and extremely satisfying. Surgery is unbelievable. As I drove home from the hospital tonight I was so tired yet I had this feeling of complete satisfaction as I pondered the events of the day. This is so much more fulfilling than anything I have ever done. It sure beats selling mattresses or pushing pharmaceuticals. I am so glad I decided to go to medical school.