Kind of a different code today

[DrQuinn]

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So I'm sitting here reading Tintinalli's when the code pager goes off. Its in the adult dialysis unit. Run/jog up there, first resident there. Guy's shiley disconnected during dialysis, he spewed out about a liter of blood then screams "I can't breath I can't breathe." Then codes. Boom. PEA. Compressions. Intubated swiftly by myself. One round of drugs. Put him in Trendelenberg, on his left side. Comes back beautifully. Hr normal, BP normal now. Transferred to CCU, private attendings. A save. Yay!

Never had a venous air embolism before.

Q

 

[Sessamoid]

So I'm sitting here reading Tintinalli's when the code pager goes off. Its in the adult dialysis unit. Run/jog up there, first resident there. Guy's shiley disconnected during dialysis, he spewed out about a liter of blood then screams "I can't breath I can't breathe." Then codes. Boom. PEA. Compressions. Intubated swiftly by myself. One round of drugs. Put him in Trendelenberg, on his left side. Comes back beautifully. Hr normal, BP normal now. Transferred to CCU, private attendings. A save. Yay!

Never had a venous air embolism before.

Q

One surgical resident I rotated with told a similar tale but which occurred when he was putting in a subclavian line. He was futzing around with something in the kit after getting the dilator on and off. He looks down at his wire and seeing blood with air bubbling out of it. He's thinking, "Uh oh, that's not supposed to happen."

Moments later, the guy looks up at him and says, "I feel like I'm gonna die! Am I gonna die, Doc? Am I?" A few moments after that, the guy coded.

Thankfully, that patient also recovered fairly promptly with the proper maneuvers.

 

[DrQuinn]

One of my EM attendings (who did several years as a surgery resident), told me a story of how he was in the SICU, and across the ICU from him a nurse was futzing with a subclavian cordis. He heard a huge "WOOOOOOOSH" of air and the patient's eyes rolled back in his eyes and he coded. My attending stuck a damn needle in the guy's heart after opening him up and got him back. CRAZY! This was out in King-Drew back in the day.

Q

 

[docB]

Central lines are dark magic. Use only when really needed. All those nurses who think every pt should have one think that because they're not responsible for the bad outcomes.

 

[Sessamoid]

All those nurses who think every pt should have one think that because they're not responsible for the bad outcomes.

An amazing number of nurses also think central lines are better for rapid infusion of fluids and blood as well. And they're talking about the triple lumen kind, not the sheath introducers.

 

[tonem]

That's funny, I was just reading that there is no scientific evidence supporting the trendelenberg with left side down maneuver...heretofore and forthwith known as the quinn manuever. Next time just wave a chicken bone around as youre intubating....it should have the same efficacy (love that doctor talk). 👍

p.s good job!

 

[DrQuinn]

That's funny, I was just reading that there is no scientific evidence supporting the trendelenberg with left side down maneuver...heretofore and forthwith known as the quinn manuever. Next time just wave a chicken bone around as youre intubating....it should have the same efficacy (love that doctor talk). 👍

p.s good job!

Yeah, i've read that its a theoretical treatment... and we don't have hyperbaric at our hospital (which is odd since we have absolutely everything else). The guy is still in the CCU but following commands. Should have been extubated last night.