don’t care if they’re cross-matched yet or not. I’ll sign. Also, tell the respiratory therapist to get in here.”
He hurried over to where Eric stood.
“She took the steering wheel in her neck,” he whispered. “At first there was just a trickle, but all of a sudden she erupted.”
“She’s drowning,” Eric murmured. “Her larynx has probably been fractured.”
“I tried calling ENT down to trach her, but they’re in the OR.”
“I don’t think it’s wise to put her head back and cut on her neck. Just paralyze her and put a tube in.”
“But … but what if I paralyze her and then can’t see past the blood to get the tube in?”
“Of course you can get it in. I’ll work the suction.”
“I … I’m not so sure that’s the right thing to do,” Reed said.
Eric glanced over at the patient and the two who were working on her. The respiratory therapist entered the room and began preparing his Ambu breathing bag.
“Reed,” Eric said softly, “it doesn’t look like you have much time. A trach will be dangerous, messy ashell, and probably take too long. The balloon on the tube you put in will tamponade the bleeding. Call for the succinylcholine. You can do it. I know you can. I’ve seen you tube a hundred people.”
“Not like her. You do it.”
“You can do it, Reed,” Eric whispered. “I’ll be right there with you. Just order the sux.”
Marshall turned to the nurse.
“Give her sixty of succinylcholine IV, please, and have respiratory set me up with a seven-point-five tube.” He looked back at Eric, who shook his head a fraction. “Make that a six-point-five,” Reed said. He crossed to the woman, whose respirations were growing less and less effective. “Mrs. Garber, we’re going to put a tube in to help you breathe. In order to do that, we’re giving you medicine that will make it impossible for you to move. Try not to be too frightened. You’ll be breathing better in just a minute.”
Moments after the rapidly acting paralytic was injected, its effects began. The woman’s muscles, including those that were enabling her to breathe, began to twitch, writhing without coordination or pattern. Then, in seconds, they all went slack. Eric set the litter back flat. Instantly, blood welled up in the woman’s mouth. He took the suction and moved to Reed’s right hand. The monitor pattern remained rapid and steady.
“Go for it,” he said, hunching next to Marshall’s ear. “Just think of the anatomy. Look for your landmarks, and concentrate.”
Reed slid the broad blade of the laryngoscope along the edge of the woman’s tongue as Eric stabilized her head with one hand and sucked the blood clear with the catheter in his other.
“Take your time,” Eric whispered, craning to see what Reed was looking at.
“I … I can’t see.”
“Wipe off the laryngoscope light and do it again. It’s only been ten seconds.”
Out of the corner of his eye, Eric saw the monitor rate begin to drop. Reed wiped the blood off the light at the tip of the blade and inserted it again. His left hand, clenched about the laryngoscope handle, was beginning to shake.
Eric reached up and depressed the woman’s larynx a bit.
“There, look,” he said. “That’s her epiglottis right there. Just come up underneath it. Easy does it. That’s it, that’s it.”
Marshall began to nod excitedly.
“I’ve got it.… I’ve got it,” he said, slipping the polystyrene tube into place. “Sweet Jesus, I’ve got it.”
Quickly, the respiratory therapist blew up the balloon on the tube, attached the breathing bag, and began a series of rapid ventilations. Eric checked the woman’s chest with his stethoscope to ensure the proper placement of the apparatus. Then he looked up at Reed and smiled.
“Hell of a good shot, old boy,” he said.
Almost immediately the flow of blood began to abate. The woman’s color improved. The relief and elation in the room were nearly palpable.
“Yes,
He hurried over to where Eric stood.
“She took the steering wheel in her neck,” he whispered. “At first there was just a trickle, but all of a sudden she erupted.”
“She’s drowning,” Eric murmured. “Her larynx has probably been fractured.”
“I tried calling ENT down to trach her, but they’re in the OR.”
“I don’t think it’s wise to put her head back and cut on her neck. Just paralyze her and put a tube in.”
“But … but what if I paralyze her and then can’t see past the blood to get the tube in?”
“Of course you can get it in. I’ll work the suction.”
“I … I’m not so sure that’s the right thing to do,” Reed said.
Eric glanced over at the patient and the two who were working on her. The respiratory therapist entered the room and began preparing his Ambu breathing bag.
“Reed,” Eric said softly, “it doesn’t look like you have much time. A trach will be dangerous, messy ashell, and probably take too long. The balloon on the tube you put in will tamponade the bleeding. Call for the succinylcholine. You can do it. I know you can. I’ve seen you tube a hundred people.”
“Not like her. You do it.”
“You can do it, Reed,” Eric whispered. “I’ll be right there with you. Just order the sux.”
Marshall turned to the nurse.
“Give her sixty of succinylcholine IV, please, and have respiratory set me up with a seven-point-five tube.” He looked back at Eric, who shook his head a fraction. “Make that a six-point-five,” Reed said. He crossed to the woman, whose respirations were growing less and less effective. “Mrs. Garber, we’re going to put a tube in to help you breathe. In order to do that, we’re giving you medicine that will make it impossible for you to move. Try not to be too frightened. You’ll be breathing better in just a minute.”
Moments after the rapidly acting paralytic was injected, its effects began. The woman’s muscles, including those that were enabling her to breathe, began to twitch, writhing without coordination or pattern. Then, in seconds, they all went slack. Eric set the litter back flat. Instantly, blood welled up in the woman’s mouth. He took the suction and moved to Reed’s right hand. The monitor pattern remained rapid and steady.
“Go for it,” he said, hunching next to Marshall’s ear. “Just think of the anatomy. Look for your landmarks, and concentrate.”
Reed slid the broad blade of the laryngoscope along the edge of the woman’s tongue as Eric stabilized her head with one hand and sucked the blood clear with the catheter in his other.
“Take your time,” Eric whispered, craning to see what Reed was looking at.
“I … I can’t see.”
“Wipe off the laryngoscope light and do it again. It’s only been ten seconds.”
Out of the corner of his eye, Eric saw the monitor rate begin to drop. Reed wiped the blood off the light at the tip of the blade and inserted it again. His left hand, clenched about the laryngoscope handle, was beginning to shake.
Eric reached up and depressed the woman’s larynx a bit.
“There, look,” he said. “That’s her epiglottis right there. Just come up underneath it. Easy does it. That’s it, that’s it.”
Marshall began to nod excitedly.
“I’ve got it.… I’ve got it,” he said, slipping the polystyrene tube into place. “Sweet Jesus, I’ve got it.”
Quickly, the respiratory therapist blew up the balloon on the tube, attached the breathing bag, and began a series of rapid ventilations. Eric checked the woman’s chest with his stethoscope to ensure the proper placement of the apparatus. Then he looked up at Reed and smiled.
“Hell of a good shot, old boy,” he said.
Almost immediately the flow of blood began to abate. The woman’s color improved. The relief and elation in the room were nearly palpable.
“Yes,
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