I'll post a case from my last night on call since the forum is dead.
RN calls me at 10:00 PM to come see ICU pt for respiratory distress.
Get to the bedside 10 min later.
Morbidly obese WM (50'ish) with RR low 40's sitting upright in bed.
Pulse 115, afib
BP 80/40's by radial A -line
spO2 89% on NRB
Weight 425 lbs
massive subq air extending up to head
Head shape/size of a pumpkin
Can not open eyes due to subq air in eyelids
Awake and will follow commands but not talking
Can open his mouth about 1.5 inches
Quick update by RN:
POD #3 from CABG, EF 45 % pre-op
Extubated POD #1
Still on dobutamine for lowish CI (has triple lumen catheter, no swan)
Chest tube and mediastinal drain removed about 6 hours previously
SQ air first noted about an hour ago - has progressed rapidly
RN and RT have already gotten abg and cxr:
ABG 7.27/65/60
CXR - tons of overlying soft tissue, bilateral pneumos -> right maybe 30%, left maybe 20%
Review intubation note by anesthesia from OR:
Performed by old school anesthesiologist - has been doing cardiac cases for 20+ years
"Grade 4 view with miller 2 - 1st pass with bougie"
This guy almost never goes with a glidescope for his 1st attempt
Available to me at this time of night:
-1 anesthesiologist with 2 crna's
-probably a couple of ER and IM hospitalists in house
-CT surgeon at home kicked back with a glass of scotch
I do 90% of my own airways but I'm not afraid to ask for help when things look ugly.
Call anesthesiologist
-he's bringing back an urgent c-section with 1 crna - doesn't feel comfortable with her starting case alone. Other crna in a case. He can be there in about 30 minutes.
What to do?
RN calls me at 10:00 PM to come see ICU pt for respiratory distress.
Get to the bedside 10 min later.
Morbidly obese WM (50'ish) with RR low 40's sitting upright in bed.
Pulse 115, afib
BP 80/40's by radial A -line
spO2 89% on NRB
Weight 425 lbs
massive subq air extending up to head
Head shape/size of a pumpkin
Can not open eyes due to subq air in eyelids
Awake and will follow commands but not talking
Can open his mouth about 1.5 inches
Quick update by RN:
POD #3 from CABG, EF 45 % pre-op
Extubated POD #1
Still on dobutamine for lowish CI (has triple lumen catheter, no swan)
Chest tube and mediastinal drain removed about 6 hours previously
SQ air first noted about an hour ago - has progressed rapidly
RN and RT have already gotten abg and cxr:
ABG 7.27/65/60
CXR - tons of overlying soft tissue, bilateral pneumos -> right maybe 30%, left maybe 20%
Review intubation note by anesthesia from OR:
Performed by old school anesthesiologist - has been doing cardiac cases for 20+ years
"Grade 4 view with miller 2 - 1st pass with bougie"
This guy almost never goes with a glidescope for his 1st attempt
Available to me at this time of night:
-1 anesthesiologist with 2 crna's
-probably a couple of ER and IM hospitalists in house
-CT surgeon at home kicked back with a glass of scotch
I do 90% of my own airways but I'm not afraid to ask for help when things look ugly.
Call anesthesiologist
-he's bringing back an urgent c-section with 1 crna - doesn't feel comfortable with her starting case alone. Other crna in a case. He can be there in about 30 minutes.
What to do?