Another airway case

[Hoya11]

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Created a throwaway account for this, because I've already asked for input from several people at my institution and it would be pretty easy to ID me:

Carrying the airway/trauma pager earlier this week. Get a page about "Level 1 trauma, GSW". I go down to the ED and I see dozens of people around the trauma bay, and a teenage male sitting up in a stretcher, blood pouring from his mouth. He has a GSW that entered in his R tonsil and exited the R external auditory canal. The trauma resident has a fistful of kerlix in the guy's mouth and is holding pressure to the R side of his oropharynx. She says "I have a pulsating artery just under my finger". He's apparently lost at least 400cc so far. They just gave 1U and are hanging another. The kid looks panicked but is able to nod yes/no.

The kid's vitals are as follows: HR 125, BP 98/60, RR 30, SpO2 98%. The trauma attending says "anesthesia, you're doing this one".

Discuss.

Copious suction. Versed, Ketamine, Glyco. Glidescope attempts by me. NO paralysis. If failure trach. Always maintain SV. I would do it right there in the ER.

 

[vector2]

The nurses at my last gig would always grow up 40 of Etomidate and I would always ask them who in the world gives 40 mg of Etomidate? And the answer would be “you’d be surprised.” That place was scary AF.

In the trauma bay here, the ED attending calls out a weight and the nurse literally calls back the calculation for 0.2 mg/kg etomidate and 1.2 mg/kg rocuronium regardless of whether the patient is GCS 15 /SBP 140 or GCS 3 / SBP 60. And that's what's pushed. I chuckle every time when I see some guy who is already halfway to jesus get 19.47 mg of etomidate.

 

[deleted697535]

Halfway to jesus ;-)

 

[dhb]

Oh god here we go again. Can’t we all just acknowledge that there are good ER docs and bad ER docs- and good anesthesiologists and bad anesthesiologists, but *ON AVERAGE* the specialty which does airways, simple and not so simple, multiple times per day for years on end, writes books about airways, holds conferences on airways, who’s at the forefront of advanced airway device development, is, again, *ON AVERAGE*, going to better in a scenario like this?

Is this where i get to say "both sides"?

 

[deleted162650]

I find it amusing that the ED guys at my shop always push lidocaine as part of their RSIs in the trauma bay. They just finished poking multiple 16’s in this dude/rectal exam/etc, but I guess they’re really worried that the induction meds might sting???

 

[deleted697535]

I find it amusing that the ED guys at my shop always push lidocaine as part of their RSIs in the trauma bay. They just finished poking multiple 16’s in this dude/rectal exam/etc, but I guess they’re really worried that the induction meds might sting???

reminds me of a trauma few years back

biker. big dude, tats, high
log rolled for the ol meet and greet

Emerg resident says, ok sir im about to put my finger in your bum

'the **** you are... you guys are nazi's man, **** you, let me outta here, **** you..'
kicking and screaming
i had to be tied down from laughing

 

[GassYous]

reminds me of a trauma few years back

biker. big dude, tats, high
log rolled for the ol meet and greet

Emerg resident says, ok sir im about to put my finger in your bum

'the **** you are... you guys are nazi's man, **** you, let me outta here, **** you..'
kicking and screaming
i had to be tied down from laughing

Careful, you might be next

 

[DocVapor]

Careful, you might be next

Whenever I'm on call and I find out that there is a particular GI also on call I always make sure to lock and bar the door to my call room, and then sleep on my back.

 

[Ronin786]

reminds me of a trauma few years back

biker. big dude, tats, high
log rolled for the ol meet and greet

Emerg resident says, ok sir im about to put my finger in your bum

'the **** you are... you guys are nazi's man, **** you, let me outta here, **** you..'
kicking and screaming
i had to be tied down from laughing

Remember a time in residency, non-English speaking truck driver comes through the ED as a trauma. I respond as the anesthesia resident and try to translate.

Surgery Resident: "Tell him I'm going to do a DRE"
Me: "Ummm, they're going to check on you down there"
Patient: "What do you mean"
Me: (Struggling to remember how to translate DRE)
Patient: "AHHHHHHH" and reaches for his bum
Me: "Yeah...that thing"

 

[alpinism]

Where in the F do you work??

Cite Soleil in Port Au Prince.