Mullberry Whine

poured out before bed

Like It Never Happened

ET tube

Diagram of an Inserted Endotracheal Tube, by PhilippN

“I can’t bag him anymore – nothing’s going in.”  The sinewy paramedic looks up at John expectantly.

John nods, takes in a sharp breath.

“Place an ET tube.”

“Placing an ET tube.”

“How are we doing on time, Jill?”  John watches the resuscitation attempt in progress grimly, glances at the fluids hanging above the patient.

“We’re at two minutes now.”

“Everybody clear, let’s check the rhythm.”  Everyone stands back, hands up.  The OB/Gyn intern who was performing chest compressions is replaced by a chiseled internal medicine intern,who with the rest of the team stares at the tele monitor.

“Still Vfib, resume chest compressions…charging…everybody clear…all clear… shocking.  Back on that chest, Jim.  Jill, let us know when 2 min is up.  Amy, please draw up 1 mg Epinephrine with a flush.”

“Drawing 1 mg Epi and flush.”

“The ET tube is in.”

“Great, what’s the capno reading?”

“It’s at 7.”

“Jim, faster compressions, please, allow for full chest recoil – excellent, looks like we’re at 12 now.  Amy, how’s that Epi coming?”

“Ready.”

“Good, administer 1mg Epi with flush.”

“Epi is in…flushed.”

“Great, please draw 150mg of amiodarone with flush.  Jill, let me know when we’re at 3 minutes post-epi.”

“Setting timer.”

“Alright, let’s think about causes guys.  He’s got multiple risk factors for both MI and PE.  He’s post-surgical so hypovolemia is also a consideration.  Lytes are always a possibility – have we got those stat labs back from before he coded?”

“Yep, normal BMP, normal tox screens.”

“We’re at 2 min, Dr. Smith.”

“Alright, everyone clear, checking rhythm…asystole…resume chest compressions.”

Carla, a slight family medicine intern with wispy arms and fine straight hair begins vigorous compressions, her blonde locks flailing back and forth like curtains in the wind.

Suddenly, there is a loud POP, followed by a wet sounding slap.

The paramedic managing the airway coughs loudly.

Lying on the floor next to him is the recently placed ET tube.  There is a red mark across the bridge of his generous nose.

Jill, begins to giggle.

“Bob, are you ok?!  Oh my god, I’ve never seen that…that’s…oh, that’s a new one!”  She is laughing hysterically, now.

Bob puts down the ambu-bag and shakes his head grinning at Carla, who has stopped CPR, standing horrified.

“Those were some chest compressions, Miss.”

Carla turns bright red as the other interns begin to laugh.

“Well, they always say, hard and fast…”

Jill tosses the mega-code checklist on a chair, turns off the monitors and resets the controls on the simulator.  On the table in front of us, the sim-man’s eyes open and begin blinking again, his chest rises and falls, a pulse now visible in his carotids.

“And they’re right, Carla, you did great.  Everyone did great.   John, well done running this one.  Of course, if that happened in real life, we wouldn’t stop and laugh.  We’d throw in a new tube and keep up CPR like it never happened… And now, let’s pretend that this never happened and start a new scenario.  Katie, you’re up.  This is a 67 yo M who presents to the ED via his wife complaining of dizziness and sudden right sided weakness starting an hour ago.  Go.”

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2 comments on “Like It Never Happened

  1. Arman
    June 25, 2013

    Like it never happened? how is that even possible? hahahaha

    • mullberrywhine
      June 25, 2013

      I nearly lost all bowel and bladder control. Intubatable manikin my right butt cheek. Hilarious!

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Creative Commons License
Nothing under the table.
***
The views expressed on "Mullberry Whine" are NOT intended to diagnose or treat disease.
***
The med-ed related stories described here are based on real events. Details have been changed in accordance with HIPAA de-identification guidelines to protect confidentiality.
***
Mullberry Whine can be enjoyed daily; there is no unsafe quantity. Real wine, though, should be enjoyed in moderation. At-Risk Drinking for males under 65 is defined as >14 alcoholic beverages per week or >4/day, with >7 drinks a week or >3/day being the cut-off for females under 65 and for anyone, male or female, who has graced this planet for 65 years for more. Drink Mullberry Whine like there are no consequences. But drink alcohol responsibly. Your friends, your family, your health-care provider, and your liver - heck, ALL of the organs in your body - will thank you.
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