Hits the Fan!"
"Unit 12 your location?" the mobile 800 megahertz radio interrupts the drone inside the ambulance cab.
The apartment appears fairly empty. It's hard to tell if these people are just moving in or if they are on their way out. Either way, they're making it pretty easy for us to find a work space (space is always a necessary commodity when working on a patient and more often than not, hard to come by. The lighting isn't good and this is going to be an issue as we progress with the call).
"Ready? One, two, three!" I count out loud as we both stand in unison. Don walks backward out the bedroom door as Mark guides him with a hand on Don's belt.
Now that I have the patient laying supine on his back his airway is quickly becoming compromised from the copious amount of blood that is pooling in his mouth. I suction this thick serous fluid with a rigid plastic catheter that is attached to flexible tubing coming from the suction machine. The cyclic groan emanating from the suction machine produces a syncopated cadence along with the moan coming from the patient! Thick clots are now becoming apparent and starting to plug the end of the suction catheter causing the groan of the machine to take on a higher octave (a pretty morbid, harmonized symphony if you ask me)! Don and Mark simultaneously begin to place the patient on the EKG monitor, obtain vital signs and prepare to obtain intravenous (IV) access in the event the patient needs fluids or medications.
"Argh!" I yell out. "You've got to be kidding me!" rocking back onto my heels. My glasses are covered with blood now dripping off of them. My face feels wet as well. Another towel is handed to me as I take my glasses off to wipe away the mess.
Time seems to be moving so slowly as we wait for Don to return with the extra equipment.
I raise my head and note that a sheriff officer with a white, handlebar mustache is standing at the foot of the patient with a camera hanging from a strap around his neck. I quickly deduce that he is the crime scene photographer and get a fantastic idea in my head.
"I'm ready when you are Mark." I anxiously wait keeping my finger in place.
There is jingling at the front door. We turn to see Don arrive from his wild goose chase.
"I couldn't find the darn thing!" Don exclaims a bit out of breath. "Oh, that'll work too!" he continues, seeing the change of treatment plan already in progress. With the tracheotomy kit readied Mark replaces my finger with his and begins the procedure (a large gauge, break-away needle is used to penetrate the crichothyroid membrane. This enables the insertion of a plastic catheter which in turn faciltates the introduction of the tracheostomy device itself).
"Help me out Gary." Mark asks, his hands starting to shake uncontrollably.
"No problem Mark, I've got ya." I respond, placing my hands on his, helping to guide the catheter in place (the plastic catheter graduates in size and increases the diameter of the insertion site as it is advanced and Mark is having considerable difficulty inserting the last of the device).
"Stand up, you have to sit on it!" I exagerate. Mark stands to straddle the patient and applying firm, controlled pressure with both hands, seats the device into place against the patients neck. After assisting with securing the device, the BVM is attached and I resume ventilations without difficulty. Finally the patients airway is secure and blood is prevented from entering his airway!
The patient is evenually packaged and moved downstairs to the awaiting gurney by the firefighters then transfered to the ambulance. A fireman drives the ambulance while Don and I both ride in the back with the patient while further care and treatment is given enroute to the trauma center.