EPTAs usual, I've got a story to tell.
After we had dinner last night with the EMTs, nurses, ambulance drivers and the shift staff, we had an eventful night. Lots of drunk people, some stab wounds and a couple folks who had a little too much food, as expected of a new year's eve shift.
Thinks were looking up at around 5AM, when I went into the residency to have a seat.
Nothing happened from there on to 9AM. I end my shift at 10AM, when a colleague arrives and recieves it.
And suddenly, the words no physician ever wants to hear when attending the ER...
CALL A CODE!!!!!
![[image loading]](http://i743.photobucket.com/albums/xx80/jerrits/4chan/ohboyHerewego.jpg)
Yeah. I actually said that.
I go into the trauma room in a hurry.
A patient has just entered the trauma room. 63 years old male. The Dynamap and vital signs monitors are being connected to the patient to assess his vitals. His daughter is with him.
Doctor, please help! He can't breathe! He has a kidney disease, he's waiting for dialysis, he was supposed to be starting next week!
I go beside the patient, put my stethoscope on and ask him "What is your name, Mr?"
Suddenly, his eyes go blank. He looks up, and collapses in the gurney. He's not breathing. My hand instinctivley goes to his neck, finding his carotid artery, although the monitors were beeping and showing me his heart rate was at around 60 beats per minute.
![[image loading]](http://www.pennmedicine.org/encyclopedia/ency_images/encymulti/images/en/9800.jpg)
TL, DR; I did THIS.
A strong pulse.
Ambu bag, STAT. Connect the oxygen line to the Ambu bag, prep a 7.5 tracheal tube, 15 mg Midazolam and get an IV access!
I begin giving rescue breaths with the ambu bag for two minutes.
Pulse saturation was reaching 30%.
Pulse saturation is one of the vital signs measured in every patient going into the ER. It tells you how much oxygen is currently being carried on the bloodstream, and it depends on a number of factors, such as how well perfusion is (how tissues are recieving the blood that the heart pumps torwards them) and how well or poorly the patient is breathing to get oxygen in his lungs.
In this case, the patient was obviously breathing poorly.
Sat did not increase in the first two minutes.
Checked for a pulse again. Stong pulse.
We're going to intubate. Prep the laryngoscope with a number 4 MacIntosh blade and the 7.5 OT tube. Push the 15 mg IV Midazolam and knock him out.
![[image loading]](http://www.aurorahealthcare.org/yourhealth/healthgate/images/FI00029_96472_1.jpeg)
An intubation. The act of putting a tube in a patients airway to deliver oxygen directly to the lungs and secure the airway.
His heart was also slowing down. It reached down to 15 beats per minute. Normal is between 60 and 90. I push an amp of IV Atropine and heartrate goes up again.
I intubate the patient on the first attempt. An EMT helps me connect the Ambu bag to the tube. I check if the tube is in the airway. It is, lungs expand properly.
And there is when I hear it.
Massive rales and stertors on both lung's bases.
He was under a massive pulmonary oedema. An accute pulmonary oedema.
Push an amp of IV Furosemide, and refrain from using any saline or other IV sollutions! He's under accute pulmonary oedema, no more volume for him!
![[image loading]](http://upload.wikimedia.org/wikipedia/commons/thumb/4/45/Furosemide.svg/653px-Furosemide.svg.png)
Furosemide. A diuretic. That is, a medication that helps the forces the kidneys into overdrive, filtering more water out to form urine.
Basically, a pulmonary oedema is when liquid accumulates in the lungs, preventing oxygen to reach the blood from the alveolii in them. That results into hypoxia (low blood oxygenation) and that can lead to a cardiac arrest, and death.
In this patients particular case, since his kidneys were shutting down, they cannot filter the excess water in the bloodstream to produce urine; hence, that water then has to go somewhere, since it cannot stay in the bloodstream forever. The patient then gets liquid in the tissues between muscles and skin, causing swollen legs and calfs, it goes into the abdomen, causing what we call "ascites", and then into the lungs, causing pulmonary oedema.
This patient did not follow his nephrologyst's instructions to refrain from having more then 1.5lts of water every day. Yesterday, he drank almost 3 liters of water.
After the tube was set and secured, and we begun pumping air into his lungs properly, sat begun to rise, patient stabilized.
I call the advanced medicalized ambulance (AMA)from my high-complexity hospital, 50 miles away.
We keep the patient stable after the incident. EMTs and physician coming in the AMA take over the patient.
30 mins away, he was entering the trauma room there.
He's now under mechanical ventilation and undergoing emergency dialysis, and currently stable.
A family will have a "happy" new year. A father and husband kept on living today after he almost died.
I certainly do. My team and I saved a life. And that's a pretty fucking happy new year.
Day[9] said "There's nothing more cool than being proud of the things that you love". I'm so proud of my staff, and so grateful for the job I get to do. And I'm proud of saving this man's life.Thank you for reading.
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