However, I have a time of great stories and medical adventures of residency that have occurred and would make great posts for my blog I just need to get caught up.
I wanted to post an experience that occurred while I was working in a medical surgical ICU. as a senior resident working in the ICU can be very stressful. In the ICU the patients are very sick often on the edge of deaths door and overnight You are the only doctor available to take care of these patients. In addition to this responsibility you are also required to respond to all code blues except for ones in the emergency department. CODE BLUES l are pronounced over the intercom as "CODE BLUE room 747" or whatever the room number is and as the ICU resident I would drop everything I was doing and literally run to the room because it meant a patient was crashing or dying. So lets just I was on call every third night and all of those calls were exciting and in no sleep occurred.
On one night I had an amazing experience where a young patient who had just recently been extubated (taken of a ventilator) who had multiple medical problems and was very sick, stopped breathing. I was immediately called to the room and the patients 's 02% was in the low 30% range which is very low and if prolonged for even a short period of time can cause severe brain injury if not death. this individual was a family man with a wife and young children and ultimately although sick should have ultimately recovered and returned to his normal life.
Upon entering the room I saw the patient's vital signs and it became very clear to me that I had to make a quick decision on how I would manage this patient. I was the only doctor there in the room a 2:00am but I had several very experienced nurses and respiratory techs to help and to lean on. As I entered the room the charge nurse said "thank heavens he is an ER doc, he'll know what to do!" which of course added to the pressure. I grabbed my intubation kit and tried to visualize the airway, without success. I grabbed a glidescope which is a fiberoptic video intubation machine that makes intubating easier on difficult airway cases. I had no luck with the glidescope either. Every second that passed = brain cells dying.
I remained very calm although on the inside I was about to pass out. I yelled out "cric kit stat!" The respiratory therapist said with a gasp "doctor, don't you need an attending physician to do a surgical airway?" I politely said "if we wait for an attending to show up, this father of 3 will be dead." The cric kit was produced and I immediately made my incision at the appropriate landmarks and found a very scarred and hard trachea as this patine had been trach'ed in the past for different medical problems. However I was able to cut through the trachea and get my gloved finger into the hole so that I would not lose the incision. I had to cut to make the hole larger and then was able to insert a tracy tube.
Immediately the thatch tube fogged with condensation of the patient's air. ALmost immediately the beeping alarms silenced and the patient regained consciousness and his vital signs returned to normal. I finished suturing the tube into place and hooked it up to the ventilator. Right about at this time an attending anesthesiologist entered the room and audibly gasped. He said "doctor wil you please note that this procedure was started prior to my arrival?" I replied "yes I will note that it was started and completed prior to your arrival." He smiled at my subtle humor and looked over my work. He examined the patients airway and said "there was no way to get this patient's airway other than what you did, nice call." Of course, this made me feel better about the decision to do the surgical airway. In looking back at the documentation this time from when I entered the room to the point where I was cutting was 38 seconds and old records showed the last time he was intubated in an OR setting it took 45 minutes with a fiberoptic scope because his airway was so scarred and difficult to get a tube through. In that setting they were breathing for him so they could take the time and it was non emergent. My setting was a little different.
I called the family at 3am and they all came in and verified that he was at his normal mental status and it did not appear that he suffered any brain damage. I told them the entire story and they were very grateful. I explained that their had to be other forces at work because everything works out perfectly and I said "I am a good doctor but not that good" and we all laughed.
The patient was discharged from the hospital 5 days later with a trach that would be removed in 3 - 4 months but he was alive and at his normal healthy mental status. Even now the experience seems like a surreal dream. Fortunately it went well. I love this job.
During my case there was lots of venous blood which I expected and fortunately no arterial bleeding.
I am truly fortunate that this case went well as they often do not and can end in death or other bad outcomes. I also am lucky that I have the privilege of doing this line of work. I love going to work.
