I just came off a month in the surgical intensive care unit (SICU). The SICU month at our hospital is fairly unrewarding. The highlight of the month was getting to carry the RICU consult pager -- known elsewhere in the world as the Anesthesia Stat airway pager. This meant that, on the days it was my turn to carry the pager, it was my job to respond to code blues and any ICU requests for airway management, intubation, and the occasional worrisome extubation. i actually enjoy going to airway consults and feel like I learn something new every time I do one.

My last airway call yesterday was rather sad. An old lady was walking on the street in Boston when she got hit by a car at high speed and dragged along the road. When I got to the ER, she was coding and getting chest compressions. The ER resident had already tried once to intubate, unsuccessfully, and the ER attending was standing at the head of the bed trying to pass the tube. The ER attending also missed and put the tube in the esophagus. I stepped up and pulled out the tube and started the mask the patient. She didn't have any teeth, her jaw kept smushing up toward her nose, and blood was coming out of the nose. It smelled fishy, like blood, but it somehow wasn't the same smell as, say, labor and delivery blood. This was, strangely, a much sharper smell. The blood coming out of her nose made her whole face slippery, so i had to use two hands while the ER respiratory therapist squeezed the bag. As I was masking the patient, they decided to call it. Patient was dead.

I let go of the mask and pulled off my bloody gloves, ducked under the suction and oxygen tubing at the head of the bed, picked up the anesthesia airway bag and walked away. I scribbled a quick note. "Patient intubated by ER attending but unable to confirm tracheal placement, so ETT removed, patient masked by RICU consult. Code called before RICU intubation attempt." I returned to the now nearly empty trauma bay to put my note in the chart. People had walked out of the room as soon as the resuscitation was finished. There was only one person left. I was quietly surprised to see the chief of trauma surgery at the head of the bed, the spot I had just left. He was holding the laryngoscope I'd left unused, bending over, one eye closed, peering into the dead patient's mouth and trying to push down a clean endotracheal tube.

I paused for a moment to take in this odd sight, then stuck my note into the chart as I had come in to do, and walked back upstairs to the monotony of the SICU.

It may be our imagination, but our Daisy seems to have grown a little!

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Another daisy picture!
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