No RBI

Cold day. temperature only a couple of degrees. Got two hours of sleep to start the shift, then went to a totally BS chest pain at an address where about ten people live and their family uses as like a neighborhood taxi service to take them down to the hospital to get every little ache and pain checked out. 50 year old lady felt a twinge when she bent down after vaccuming. Only lasted a minute. Warm, dry, ambulatory, the works.

Then we did an elderly lady with a high fever, and then as we were clearing that call, we heard the cops being sent to a local nursing home for a code, a city ambulance already in route. So they sent us to back the city rig up. We had to put on masks to enter the room. The lady had MRSA in her sputum. I asked the city medic how I could assist her. She said she couldn't get the tube, maybe I could try. The lady's neck was completely stiff. She was asystole, but they said she was always sort of stiff. I tried a couple times to get the tube. There was no play at all in her neck. I couldn't see the chords, so I tried the bougie, but I went in the esophagus. The mouth was full of crap. I tried to look in using the ice pick method, but couldn't see anything, then tried to do it digitally, but couldn't get my hand in. Another city medic showed up and he ended up getting the tube. I got an EJ and we did three cycles of drugs with no effect, then called her dead.

I admit to being a little disappointed I didn't get the tube. I always get the tube. Its a point of pride. I probably would have gotten it eventually if I was on my own, but when other medics are there you have to take your shot then pass the scope. I know what I did too. I should have lifted higher to the right and knelt down lower, then maybe I might have seen the chords. I'd like to try again.

It's the first tube I haven't gotten in years so I guess I was due to have trouble. The fact of the matter is I just don't get enough intubation attempts to have the proficiency I would like. I average 12 tubes a year. Last year I only got 8. I got all the tubes I tried, but you really should be doing 20 or more a year.

I'm much better than when I first started. Or maybe I've just had easy tubes. No, I've tough ones and I've managed to get them -- not always on the first try. But not this one. I feel like a ballplayer who failed to drive in the run.

***

There was a big article in the latest Journal of the American Medical Association about the poor quality of CPR being done, and I have to admit I've seen my share of codes where people forget to do continuous chest sompressions. Sometimes even when they are doing them, they are doing them poorly.

Here's the link to the article:

http://jama.ama-assn.org/cgi/content/full/293/3/299

***

Last call of the day was a guy with abd pain from a doctor's office.

Working tomorrow. A blizzard is on the way.