Now I lay me down to sleep…

I rushed into the resucitation room after seeing our flight crew run down the hallway with a gurney. The trauma team was gowned and ready, and I didn’t even know there was a flight coming in. THat’s how busy we were last night.

I quickly dressed in a trauma gown, hat and sterile gloves as I looked at the soot covered ten-year old. His hair was uniformly singed to about 1/4″ from his head. Peeling skin blistered his face arms and legs. The only skin spared from either burns or soot was his perineal area (the groin), which had been covered by the boxers he was sleeping in.

The trauma surgeon looked me in the eyes and said with as much authority as I’ve ever heard. “He needs to be intubated now.” Intubating. That’s my job. As the senior ER resident in the department, I am in charge of managing the airways on all resuscitations, even if the trauma team is caring for the patient.

Formulas raced through my mind for tube sizes. Cuffed or uncuffed? I didn’t have time to think it through clearly. I slowed myself down. (Step one: Take your own pulse). I set up a non-rebreather mask with oxygen. He was still awake and breathing on his own, but with facial burns and soot, you have to assume that his airways are burnt as well. I set up suction, prepared intubation supplies, tested the balloon, and called out verbal orders to give induction and paralyzing medicines.

We put him to sleep, he relaxed and ventilated easily with a bag valve mask. I looked down into his throat with a long metal blade designed to expose the vocal cords. The halogen glow lit up bright red mucosa and I spotted the hole going into his lungs. I didn’t see vocal cords, instead, I saw black soot. Had he just inhaled the smoke or were his vocal cords burnt as well? His voice had been soft and quiet, maybe that’s why. I can’t imagine how much pain he must have been in.

He was taken to the pediatric ICU for stabilization. About an hour later, a distraught couple arrived. She was also covered in soot, but spared the blistering skin that had covered her son’s body. If she hadn’t woken him from sleep, he would surely have been dead.

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