OK, I’ve lied about nothing interesting happening on cardiology. As upper levels, the two of us are supposed to run any “codes” that occur in the hospital. The other morning, I heard the overhead system announce a code on one of the medicien floors. I set my fresh coffee on a payphone, grabbed my coat pockets to keep them from flapping in the breeze, and took of for the pavilion, taking a short cut through the ortho clinic to get there. I was about the 4th or 5th person there and not sure if I should stay or not…the other team was already there. I pushed my way past the code cart to see the rhythm on the monitor…what was it? No one was sure. Did she have a pulse. No one could feel a pulse. While we were trying to decide if it was shockable, I started CPR. The resident at the head of the bed called for the intubation tray. We shocked her…it looked like she was in v-fib. Anesthesia showed up.
“Have you tried to intubate yet?”
The resident took a look with the laryngiscope and slide the tube in while I continued compressions.
“It’s in”, he said. THey started to ventilate. I smelled stomach acid.
“Are you sure?” I asked.
“Yes, it’s in.” he repeated.
I asked for the carbon dioxide detector…a clever device that turns “Yay for Yellow” if the tube is in the lungs. “Just look again with the laryngiscope,” I told him.
“I saw it go in,” he insisted.
Her belly got bigger. “I hear breath sounds an intern said.” I continued compressions. Finally the detector was on. “Its in, it’s purple.”
“It’s supposed to turn yellow!” I grunted. I stopped compressions and let someone else take over. I grabbed the laryngiscope and looked again…Just below her epiglottis, I saw a nice black v-shaped opening leading directly to her lungs. The tube was below it, going towards her belly. I pulled it out, got a good look and slid it right between the vocal cords. The detector turned yellow. Her belly deflated. Her lungs inflated. Her cardiac rhthym changed again now that she was being oxygenated. We shocked her again and I checked her blood pressure…she had both a rhythm and a perfusing pulse.
My pager went off. I grabbed the patient phone from the empty bed next to me. “I’m at a code,” I told my fellow.
“Is the other team there? They can run it.”
I looked around the room. She was tubed, had a pulse and a blood pressure. By now there were about 15 people in the room and more in the hallway. “I’ll be down in a minute,” I told him.