red, white and blue
i'm not talking about the stars and stripes, but of the range of colors i have seen on the other side of the drape these last few weeks on my anesthesia rotation. looking at someone's cheeks is more telling that i ever would have thought.
yesterday we put an obese man w/ long history of smoking to sleep. we paralyzed him, and then tried to bag him (ventilate his lungs with a bag mask and some oxygen). his neck was so fat that we couldn't. in the 30 seconds or so it took the anesthesiologist to get the plastic tube and laryngoscope ready, he desaturated down from high 90s into the low 60s. his blood went from holding 90% of the oxygen he breathed to holding only 60%. most people don't desaturate that quickly, but when you're a smoker, your lungs are already so irritated and damaged that they can't tolerate much.
his face turned pale pale blue. good thing she got the tube in, because if not, he could have died. we couldn't ventilate him so unless we get that tube in, he has no way to breathe because he has already been paralyzed.
i've never seen that color blue.
red was a woman (also a smoker) who was coughing so hard that her face couldn't help but flush. apparently this is a typical response for smokers because there lungs are so irritated. she was beet red. she struggled so much with the coughing that she ended up biting her tongue and bleeding all over the place.
white was the woman who went into laryngeal spasm. the back of your neck/mouth area is the larynx. when that part is traumatized, there are muscles that can contract so much that you can't relax enough to get air in.
we tried 4-5 times before we reversed the spasm. she was choking and coughing and struggling for air. like she was drowning it looked so horrible. and struggling just makes the spasm worse. but it's so hard to tell someone to relax when they can't breath.
her face was so blanched. she was the first person i tried to intubate. i tried twice and couldn't get it. i think it was my multiple attempts that irritated her larynx and made her spasm. the ER resident said it probably wasn't my fault, she was a smoker too and that increases the risk for spasm. i don't know, my bet would be that putting a big metal object and a tube down her throat numerous times is more likely to cause irritation than smoking. it felt awful to have contributed to her pain. i have been more careful and much less aggressive since.
i can't get these faces out of my head. it's haunting trying to control someone't breathing...the very thing that gives people everything they need. blood can be replaced, injuries can be patched up, but you lose an airway and you're completely screwed. and it all happens so fast. people have no idea the extent to which they really entrust doctors with their lives. it really is remarkable.
the anesthesiologist i worked with today is totally racist so sometimes it's hard to hold my tongue. despite that she is an excellent teacher and incredibly smart. she said something today that i wanted to write down, it's nothing original, but it just resonated with me today:
"never trust anyone to do something for you. never trust anyone but yourself; sometimes it's difficult enough simply to trust yourself, that's difficult enough."
yesterday we put an obese man w/ long history of smoking to sleep. we paralyzed him, and then tried to bag him (ventilate his lungs with a bag mask and some oxygen). his neck was so fat that we couldn't. in the 30 seconds or so it took the anesthesiologist to get the plastic tube and laryngoscope ready, he desaturated down from high 90s into the low 60s. his blood went from holding 90% of the oxygen he breathed to holding only 60%. most people don't desaturate that quickly, but when you're a smoker, your lungs are already so irritated and damaged that they can't tolerate much.
his face turned pale pale blue. good thing she got the tube in, because if not, he could have died. we couldn't ventilate him so unless we get that tube in, he has no way to breathe because he has already been paralyzed.
i've never seen that color blue.
red was a woman (also a smoker) who was coughing so hard that her face couldn't help but flush. apparently this is a typical response for smokers because there lungs are so irritated. she was beet red. she struggled so much with the coughing that she ended up biting her tongue and bleeding all over the place.
white was the woman who went into laryngeal spasm. the back of your neck/mouth area is the larynx. when that part is traumatized, there are muscles that can contract so much that you can't relax enough to get air in.
we tried 4-5 times before we reversed the spasm. she was choking and coughing and struggling for air. like she was drowning it looked so horrible. and struggling just makes the spasm worse. but it's so hard to tell someone to relax when they can't breath.
her face was so blanched. she was the first person i tried to intubate. i tried twice and couldn't get it. i think it was my multiple attempts that irritated her larynx and made her spasm. the ER resident said it probably wasn't my fault, she was a smoker too and that increases the risk for spasm. i don't know, my bet would be that putting a big metal object and a tube down her throat numerous times is more likely to cause irritation than smoking. it felt awful to have contributed to her pain. i have been more careful and much less aggressive since.
i can't get these faces out of my head. it's haunting trying to control someone't breathing...the very thing that gives people everything they need. blood can be replaced, injuries can be patched up, but you lose an airway and you're completely screwed. and it all happens so fast. people have no idea the extent to which they really entrust doctors with their lives. it really is remarkable.
the anesthesiologist i worked with today is totally racist so sometimes it's hard to hold my tongue. despite that she is an excellent teacher and incredibly smart. she said something today that i wanted to write down, it's nothing original, but it just resonated with me today:
"never trust anyone to do something for you. never trust anyone but yourself; sometimes it's difficult enough simply to trust yourself, that's difficult enough."
posted by heyrod at 10:03 AM
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