Roadtrips. The bane of my existance as an upper level resident. Taking critically ill patients off the floor for imaging tests, drainage of abcesses, MRIs, etc. Things always go bad at inopportune times, like waiting in the elevator for example…
The patient I whose bed I was rushing down the first floor hallway had been festering at an outside hospital for days. He had kidney failure, liver disease and lay in his bed bleeding to death from a dialysis fistula before anyone bothered to check on him. He had bacteria growing out of his blood, pus filling his lungs and oozing skin abcessess on his elbows of all places.
As soon as we left the unit with him, his oxygen saturation began to drop. Riding in the elevator on the way to the first floor, it had reached 90%. The elevator was too cramped to find his finger sensor and make sure it was working. The patient was unresponsive. We began rolling down the hallway to the radiology suite as I read aloud his saturations to the nurse and the respiratory therapist. 88, 87, 86. Stories of patients crashing in CT, XRay or MRI began to bubble to the surface of my mind.
“Let’s just get him in the room,” the therapist said. There we can plug the portable ventilator into the wall oxygen supply, although there was no reason the portable vent shouldn’t being working right.
CT wasn’t ready for us, but by now his sats were 80%. I wheeled him into the room, uninvited, and the radiology crew immediately recognized our urgent problems. We plugged the oxygen tubing into the wall, took him off the portable ventilator and started manually squeezing air into his lungs. His sats were in the 70s now.
I couldn’t figure out what was happening, or why. I watched his EKG monitor closely, waiting for signs of QRS widening and vfib. His blood pressure was 90/30. I flashed forward to calling an adult code from the CT scanner…the Emergency Room residents respond to first floor codes and I almost looked forward to my colleagues and mentors rushing to my aid. But for the time being, he was still not quite crashing. He wasn’t quite dead yet. I had the nurse run some fluid through his IVs. His sats came up slowly with the bagging. Finally, he was back to 100%, his blood pressure was 112. We got him on and off the table as quickly as possible, then wheeled him back to the ICU as fast as possible.
My own heart was pounding by the time we got back, but the patient was still saturating 100% and was now back in his bed. I told the attending how close I came to calling a code. He performed another bronchoscopy on the patient, his 2nd in 4 hours, and sucked out gobs of pus from his lungs. I felt like I had narrowly escaped having a patient crash while off the floor…which is the whole reason ICU residents go on road trips in the first place.