CPR

One of the most exciting parts of my first night on call in surgery was the CPR.

Let me set the stage, first.

Both myself, and my good friend in medical school, "Stormcloud", were on call. I was on the general surgery service, and he was the pediatric surgery service. We had had a good time in the ER, taking patients that were interesting, and working them up. Okay, maybe the work-up was a little boring, but getting to staple people in the head was kind of cool. I still get a kick out of it. Anyway, we had finished that, and had also seen one of my patients who was slowing shitting his blood volume out. We decided that we had gone above and beyond the call enough for one night, and decided to turn in. We had gotten to the call room, and were getting into our respective bunks, trying to puzzle our way through mister BRBPR*, when we heard a room get toned out. It was on our floor. So, quick as a flash, we pulled our shoes on and headed towards the sound of people yelling.

FYI; I blame this completely on Stormcloud. He did earn that nickname for a reason, after all.

We doffed our white jackets, and strode into the patients room like a couple of pros, even though we weren't. It was some woman whose upper torso and face was bathed in orange vomit. Her eyes were wide and staring. She was in PEA**, and one of the docs started calling for bicarb and dopamine and some other stuff. When we walked in, the nurse pushing the drugs was screaming that someone needed to start compressions, but most people seemed a little hesitant to get their hands into the puke. There was an RRT (registered respiratory tech) who was working the BVM***. The criticval care doc looked at an intern, stormcloud and myself, and told us to start compressions. I actually ended up getting in first. I started banging away at this chicks chest. Something became obvious to me pretty quick. The BVM was not working well. The RRT was not holding the mask to the face, and therefore, did not have a good seal. This was reinfirced by the fact that I could only feel an occasional thrill under my hands when the lungs were inflated. I suggested that he check the seal, and he dismissed me with "it's OK, don't worry about it." And I didn't; right about then, as I pressed down, I felt one of the ribs snap on the right side of the girl's chest.

I kept going at about 80 a minute. I yelled out that the rib had broken since it might be important to be aware of it if certain sequelae occur. A broken rib can do all kinds of nasty stuff if you keep pounding on someone's chest after it is broken. You can puncture the lung, leading to collapse, or blood filling the space around it, leading to compression. You can also end up with air in the mediastinum. Perhaps most problematic is if you pierce the sac surrounding and protecting the heart, leading to cardiovascular compromise. Anyway, I did not have time to worry about what damage I might be doing to this vomit soaked woman. If any of these became an issue than it would mean that she was worrying about them in hours, and right now we were worried about the next 30 minutes.

Shortly thereafter, anaesthesiology showed up. She told us to stop compressions while she intubated. We rotated. Compressions are tiring to do. You have to expend a whole lot of energy, and it is made more difficult by the fact that she was on a hospital bed, which required both more force and more movement. The aneasthesiologist dropped the tube. Air exchange was still pretty bad. They started suction through the tube and pulled out a fair amount of fluid from the lungs. my guess was aspirated vomitus. More bicarb, a few more rotations on compressions, an ABG later, and we had gotten her a pulse back.

Afterwards, both Stormcloud, the intern, and myself were given strong props by the critical care fellow for our efforts. "Strong work", he said, "strong work." The patient was transferred to the ICU****, and from what I hear, coded again later that night. Tomorrow, I will try to find out if she made it.

Most people I know run from codes. They do not want to get involved. I guess to a certain degree, I can understand this. Who wants to drop everything and haul ass to try to helpa a patient, who, statistically is not going to survive even 24 hours even if you do get a pulse back? It's hot, tiring, often messy, and always stressful. Stormcloud and I are different, though. I guess we are. Maybe we just haven't yet burned out. I don't know about that, though. I kind of like that place in medicine. I like that place in a lot of things. I don't know what you call it, but I guess if I was to assign it a name, I would call it the contested ground. It's that place and time when you have broken past a defender, and are skating toward the goalie, with the puck on your stick ready for a forehand shot. It's when you are asking that high school hottie in your math class out for a date. It's Where your car has started to skid on the icy road. It's that place where the outcome is in jeopardy. The goalie may block, the hottie may shoot you down, the tires may not regain their traction. But you are there. You are the margin. So, you fake a little deke to the left, flash your most diasarming smile, turn into the skid. One one side is a winning goal, hot date, and safe return. On the other is defeat, rejection, and injury. It is excitement and terror in the same instant.

For many, the terror of failure is more than their ego will risk. For me... I just like it. I like being on that thin edge where order and chaos make war. It is in that margin that we know what we are.

We are what we do when it counts.

Respectfully Submitted,

doc Russia

*Bright Red Blood Per Rectum.

**Pulseless Electrical Activity. When electrical activity on the Electro Cardio Gram does not correlate to a palpable pulse

***Bag Valve Mask. A mask attatched to a one way valve and a plastic bag. It is used to deliver air to a patient who cannot breathe for themselves

****Intensive Care Unit. Really sick patients who require constant care and monitoring are generally sent here.