Great Night

I like working overnight. There is a certain buzz in the air from midnight into the early hours of the morning. None of the administrative heads are there so the staff seems a little more laid back and not on edge. It is less formal. The individuals that work nights are also a little more interesting so all the nurses and ancillary staff have a different vibe. I like the night.

Last night I worked from 11:00 pm to 8:00 am and my most interesting case was a 54 y/o alcoholic male who was found on the street in a pool of blood. After cleaning him up and looking for the source of the blood we were able to determine that it was coming from his GI tract. Ultimately he became fatigued with his breathing and I watched as he struggled know that we were going to have to intubate him.

I was able to go to the head of the bed and with the senior resident helping I intubated the patient. First you pre-oxygenate the patient by giving 100% oxygen. This helps his body build up reserves so that he won't crash while you are trying to get the breathing tube in and he is getting no oxygen. Then you administer a few medications to paralyze and knock the patient out. Once the patient is out you use an instrument to expose the airway through the mouth. Once you see the vocal cords you know you are there. You slip the tube between the cords and push it down the trachea. Once in place you supply oxygen and listen to both lung fields to make sure you are in the correct place. You also check placement with a chest xray.

Following successful intubation the patient is hooked up to a ventilator and remains in a sedated state while the various health problems are addressed and hopefully fixed so that the patient can be weened from the ventilator. Intubation can be a stressful procedure because the clock is ticking and many times due to anatomy or other factors it can be difficult to find and get an airway. While you are attempting to intubate the patient is not receiving oxygen so you have to be quick. There are also a handful of complications that can occur as well which also add to the stress of the procedure.

I love it. It was a great night. The patient lived.