Tae 7 - Re: Bad, really bad, clams. And Me
vineland expatriate writes: "When the patient became alert enough to come to and pull the tubes out *himself*. Tae can describe for us how painful an intubation must be; the important point to bear in mind is that the toxins in question, the saxitoxins, prevent essentially all your nerve and muscle impulses from moving from point A to point B."
Tae writes:
Intubations _are_ pretty painful, but _extubations_ are worse.
ObTastelessCaseInPoint:
I had two separate calls this week that involved intubations. The first intubation was for an elderly women having congestive heart failure. CHF, as the acronym goes, is basically your heart not having enough 'pump' strength to push fluid out of the heart, so the fluid begins to back up into the lungs, which slowly begin to fill up. Sorta like drowning in a swimming pool - only it's in your living room.
Anyway, she needed to be intubated, to help her breathe. I opted to nasally intubate her. That is, pass the tube through her nose, down her throat, and into the trachea. Apparently this is more comfortable for the patient than passing the tube through the mouth and into the lungs. I don't know - they both seem pretty uncomfortable-looking to me.
After liberally lubricating the tip of the tube with K-Y jelly, I began to thread the tube through her left nostril. The first few inches were no problemo, then I heard/felt a 'crunching' noise as I passed the tube further down. I finished passing the tube into the woman's lungs, and noticed quite a bit of blood coming from her mouth. Now a little blood after such a procedure is not unheard of, but this was a _lot_ more than usual. After confirming the placement of her tube by listening to her lungs, we 'packaged' the patient and transported to the hospital. All the way over, she continued to bleed from her mouth.
When we arrived at the hospital, the ER staff noticed the blood and commented on it as well. An anesthesia resident showed up, when we asked him what could cause such bleeding, he asked whether the intubation had been difficult, and whether we heard a 'crunching' noise during the
procedure.
"Yes, that's exactly what I heard - and felt!" I said.
He looked at the woman's hospital chart, and said: "Well, that explains it. This woman has a history of seasonal allergies, which means that her nasal turbinates were probably engorged with fluid. That crunching noise you heard was the sound of all the nasal turbinates *popping* as the tube passed them."
The second intubation was for a 'woman down' call. We were called to a record store in Harvard Square. When we arrived, there was a woman in her early-twenties on the floor in between the aisles of records. She looked quite attractive: summer print dress, combat boots, a half-dozen ear rings in one lobe. If only she didn't look so ... blue. Since she was completely unconscious I opted to orally intubate her. My partner - perv that he is, took one look at this non-sixty, non-overweight woman, and pulled his shears and said "The clothes _have_ to come off!"
With a deft, if not trembling, application of the shears - off came one summer print dress. Seeing as we were in a record store, my partner was discreet enough to leave the panties alone, and opted just to cut the bra off. Her breasts sprung out of their cotton confinement - to the collective 'oohs' and 'aahhs' of my partner, the firefighters, well, just about every male in the store. All I can say is that the tattoo she had _must_ have hurt when she got it. Ahem, where was I? Oh yes - the intubation.
I easily passed the tube into her lungs, and she began to 'pink' up a bit. My partner started an IV, and gave her a squirt of 'Narcan,' which reverses narcotic overdoses - which is what this turned out to be. The Narcan works rather fast: about a second after he injected the Narcan, the patient sat up, pulled the endotracheal tube from her throat, and promptly puked all over the floor.
If you've never seen an endotracheal tube, let me describe it:
A plastic tube about a centimeter in diameter, with a 'cuff' at the end of it. This cuff is left uninflated prior to intubation. After the tube is placed, the cuff is inflated with about 10 cc's of air, holding the tube snug in the bronchus, and achieving an air-tight seal. When people (such as the girl) pulls the tube out before a trained medical professional (like myself) has a chance to deflate the cuff, the result is the cuffed-end of the tube, which is now three-times its original diameter being pulled up the bronchus, up the throat, and out the mouth. In its travels, the tube is now big enough to 'tickle' the tonsils, and initiate a 'gag' reflex, which lends itself to large amounts of vomit.
After she finished puking, she looked straight at me and said "Hi Tae."
I hadn't recognized her before - she was a girl that frequently called for her junkie boyfriend. Never knew she was a junkie herself. Oh well. We transported her to the local hospital, and I was completing some paperwork, when a nurse came up to me asked me to talk this girl, as she was getting a bit nasty. I walked into the room where she had been placed and tried to calm her down.
"Hey Annie, how's your boyfriend doing - I haven't seen him around in a while."
"He OD'd and died last week."
"Oh, sorry. Well, gotta go now."
As I was leaving, they were busy putting leather restraints on her. So much for calming her down.
- Tae
(Originally posted on Sat, 2 Jul 1994)
Louise K. Rogow writes: "Tae wrote: "
: 1) Should this be cross-posted to alt.sex.bondage?
: 2) I thought that those restraints were some synthetic fabric and velcro.
: 3) GIF GIF GIF!"
2) There are _many_ different types of restraints available to the - ahem - medical professional:
A) The traditional leather restraint - now falling out of favor, since leather is damn hard to clean, and does not conform to OSHA standards for blood-borne pathogens.
B) The new hard plastic restraints, same design as the leather one, but easier to clean. Every time I see them, brings a nostalgic tear to my eye. Gone are the days when one could say: "I think he/she/it needs the _leathers_."
C) A pre-packaged, single-use restraint, which is made of foam-padding, and skimpy-looking straps.
ObAside: I once applied this type of restraint on a person who had just taken PCP. During the ride up to the hospital, I kept whispering in his ear that he had killed his entire family. Since he was rather disoriented, and probably couldn't see straight, _and_ was restrained, I figured he
would be no problem.
We arrived at the hospital, wheeled the patient into the ER lobby. He was still restrained to the stretcher. He came to, and the ten minute 'whisper' session I had with him finally connected. With a roar, he rocked back-n-forth, until the stretcher tipped-over, he got to his feet - _with the stretcher still tied to him_, and ran out of the ER and down the street. He then noticed the flimsy restraints on his arms, and snapped them off with a shrug. The stretcher fell away from him, and with another load roar, he ran away, howling into the night.
"He's getting away! Somebody do something!" said a nurse.
"Listen, if you think I'm going after him - you're crazy." said my partner.
"Don't look at me - you're just lucky he didn't think you were a bottle of soda - with a twist-off top."
3) Still trying to take some pixs at calls - give me some time.
>Keep the Faith, Louise who would love some medical-grade leather restraints
Tae, who would be happy to get a pair for you - only if he gets to apply them
(Originally posted on Wed, 6 Jul 1994)
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