In times of crises, certain traits are desirable and some, admirable. One of those is situational awareness. What is most desired is knowing your limits and calling for help.
A competent registrar notified me of an impeding airway disaster:
A competent registrar notified me of an impeding airway disaster:
- Semi conscious patient in respiratory distress
- Oro-pharyngeal tumour (undergoing chemo)
- Bleeding acutely from unknown site in oropharynx or lower
- Shocked clinically
- The best description I can give to those who understand is "peri-arrest".
Here's the really good news though:
- A RSI checklist had been commenced prior to my arrival
- The airway team had been called
- Nursing staff were ensuring all the items on afore-mentioned checklist were prepped
- Tranexamic acid given
- Cric kit was opened and location marked (as best we could due to oedema)
The inevitable happened and the soon GCS deteriorated as did BP. Subsequently, this followed:
- Ketamine
- Unmatched blood as soon as we got it
- Peripheral pressors
- Paralysis and attempt by Anesthetist
- Continuous suctioning of blood with no view of cords
- Bougie assisted intubation with no desats and good CO2 trace
- Good post intubation care
The whole hospital team successfully oxygenated and ventilated this patient. I did practically nothing. Which is why I am elated. This was a triumph for systemic preparation & team sport...
... but it all started with a keen-eyed doctor with the sense to know they couldn't do it all by themselves.
Remember:
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