While doing mid-morning rounds on the floor, the operator paged anesthesia emergenty overhead to the coronary unit. My intern and I locked eyes and wondered aloud who it was. Our attending glibly said, “It’s just for anesthesia, someone needs to be intubated. You don’t have to go.” Which really meant, “Don’t go, moron.” The intern and I locked eyes again…we had 5 of the 18 patients in the CCU. I took off running down the hall.
Sure enough, it was one of OUR patients whose endotracheal tube had begun to leak. There were about 3 or four nurses around the bed, the intubation box was open, and one of our nurse anesthetists was pulling equipment out of the box. In the 5 minutes since our team had left his bedside, the patient began to cough, pushing the tube out. His tidal volume on the vent dropped to about 1 ounce of air moving in and out. (instead of the usual 1/2 liter or more) I could understand the nurse’s urgency in calling anesthesia to bedside, but was a little irked that they hadn’t paged one of us instead.
I politely asked the anesthetist, whom I’ve worked with before, if he wouldn’t mind if I took a look first. After all, he’s finished his training, and the whole reason I’m in residency is to learn how to deal with emergent scenarios and procedures…if all cases were easy, I’d be in practice right now! I gave him extra sedation and I gently looked down his throat with the laryngiscope blade and nudged the tube in a little further past his vocal cords. His oxygenation improved as did his volume of air he was moving.
When I returned to rounds, the interns and fellow were curious about the incident, but the attending tried to quickly refocus rounds on the current patient. She just shrugged a bit when I told her it was one of ours. I think there are some alpha female issues at work on service this week, but thankfully, only five more days to go, with turkey day off!