From: st871622@pip.cc.brandeis.edu (not him again)
Subject: RE: Bad, really bad, clams. And Me.
Date: Sat, 2 Jul 1994 00:40:25 GMT
bell@minerva.cis.yale.edu (vineland expatriate) writes:
: mechanisms they had running..... When the patient became alert enough
: to come to and pull the tubes out *himself*. Tae can describe for us
: how painful an intubation must be; the important point to bear in mind
: is that the toxins in question, the saxitoxins, prevent essentially all
: your nerve and muscle impulses from moving from point A to point B.
Intubations _are_ pretty painful, but _extubations_ are worse.
ObTastelessCaseInPoint:
I had two separate calls this week that involved intubations. The first
intubation was for an elderly women having congestive heart failure. CHF,
as the acronym goes, is basically your heart not having enough 'pump'
strength to push fluid out of the heart, so the fluid begins to back up
into the lungs, which slowly begin to fill up. Sorta like drowning in
a swimming pool - only it's in your living room.
Anyway, she needed to be intubated, to help her breathe. I opted to
nasally intubate her. That is, pass the tube through her nose, down her
throat, and into the trachea. Apparently this is more comfortable for
the patient than passing the tube through the mouth and into the lungs.
I don't know - they both seem pretty uncomfortable-looking to me.
After liberally lubricating the tip of the tube with K-Y jelly, I began
to thread the tube through her left nostril. The first few inches were
no problemo, then I heard/felt a 'crunching' noise as I passed the tube
further down. I finished passing the tube into the woman's lungs, and
noticed quite a bit of blood coming from her mouth. Now a little blood
after such a procedure is not unheard of, but this was a _lot_ more than
usual. After confirming the placement of her tube by listening to her
lungs, we 'packaged' the patient and transported to the hospital. All the
way over, she continued to bleed from her mouth.
When we arrived at the hospital, the ER staff noticed the blood and
commented on it as well. An anesthesia resident showed up, when we
asked him what could cause such bleeding, he asked whether the intubation
had been difficult, and whether we heard a 'crunching' noise during the
procedure.
"Yes, that's exactly what I heard - and felt!" I said.
He looked at the woman's hospital chart, and said:
"Well, that explains it. This woman has a history of seasonal allergies,
which means that her nasal turbinates were probably engorged with fluid.
That crunching noise you heard was the sound of all the nasal turbinates
*popping* as the tube passed them."
The second intubation was for a 'woman down' call. We were called to a
record store in Harvard Square. When we arrived, there was a woman in
her early-twenties on the floor in between the aisles of records. She
looked quite attractive: summer print dress, combat boots, a half-dozen
ear rings in one lobe. If only she didn't look so ... blue. Since she was
completely unconscious I opted to orally intubate her. My partner - perv
that he is, took one look at this non-sixty, non-overweight woman, and
pulled his shears and said "The clothes _have_ to come off!"
With a deft, if not trembling, application of the shears - off came one
summer print dress. Seeing as we were in a record store, my partner was
discreet enough to leave the panties alone, and opted just to cut the bra
off. Her breasts sprung out of their cotton confinement - to the
collective 'oohs' and 'aahhs' of my partner, the firefighters, well, just
about every male in the store. All I can say is that the tatto she had
_must_ have hurt when she got it. Ahem, where was I? Oh yes - the
intubation.
I easily passed the tube into her lungs, and she began to 'pink' up a
bit. My partner started an IV, and gave her a squirt of 'Narcan,' which
reverses narcotic overdoses - which is what this turned out to be. The
Narcan works rather fast: about a second after he injected the Narcan,
the patient sat up, pulled the endotracheal tube from her throat, and
promptly puked all over the floor.
If you've never seen an endotracheal tube, let me describe it:
A plastic tube about a centimeter in diameter, with a 'cuff' at the
end of it. This cuff is left uninflated prior to intubation. After the
tube is placed, the cuff is inflated with about 10 cc's of air, holding
the tube snug in the bronchus, and achieving an air-tight seal. When
people (such as the girl) pulls the tube out before a trained medical
professional (like myself) has a chance to deflate the cuff, the result
is the cuffed-end of the tube, which is now three-times it's original
diameter being pulled up the bronchus, up the throat, and out the mouth.
In it's travels, the tube is now big enough to 'tickle' the tonsils, and
initiate a 'gag' reflex, which lends itself to large amounts of vomit.
After she finished puking, she looked straight at me and said "Hi Tae."
I hadn't recognized her before - she was a girl that frequently called
for her junkie boyfriend. Never knew she was a junkie herself. Oh well.
We transported her to the local hospital, and I was completing some
paperwork, when a nurse came up to me asked me to talk this girl, as
she was getting a bit nasty. I walked into the room where she had been
placed and tried to calm her down.
"Hey Annie, how's your boyfriend doing - I haven't seen him around in a
while."
"He OD'd and died last week."
"Oh, sorry. Well, gotta go now."
As I was leaving, they were busy putting leather restraints on her. So
much for calming her down.
- Tae
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From: st871622@pip.cc.brandeis.edu (not him again)
Subject: Re: Bad, really bad, clams. And Me.
Date: Wed, 6 Jul 1994 17:18:18 GMT
In <2va9rf$d0d@access1.digex.net> "goddess@access.digex.net" "Louise K. Rogow"
writes:
: In article <1994Jul2.004025.11649@news.cs.brandeis.edu>, not him again
: wrote: >As I was leaving, they were busy
: putting leather restraints on her. So >much for calming her down.
:
: 1) Should this be cross-posted to alt.sex.bondage?
:
: 2) I thought that those restrainst were some synthetic fabric and
: velcro.
:
: 3) GIF GIF GIF!
1) Well, there was no sex involved - just bondage.
2) There are _many_ different types of restraints available to the - ahem -
medical professional:
A) The traditional leather restraint - now falling out of favor, since
leather is damn hard to clean, and does not conform to OSHA standards
for blood-borne pathogens.
B) The new hard plastic restraints, same design as the leather one, but
easier to clean. Every time I see them, brings a nostalgic tear to my
eye. Gone are the days when one could say: "I think he/she/it needs
the _leathers_."
C) A pre-packaged, single-use restraint, which is made of foam-padding, and
skimpy-looking straps.
ObAside: I once applied this type of restraint on a person who had just
taken PCP. During the ride up to the hospital, I kept whispering in his
ear that he had killed his entire family. Since he was rather disoriented,
and probably couldn't see straight, _and_ was restrained, I figured he
would be no problem.
We arrived at the hospital, wheeled the patient into the ER lobby. He was
still restrained to the stretcher. He came to, and the ten minute 'whisper'
session I had with him finally connected. With a roar, he rocked back-n-
forth, until the stretcher tipped-over, he got to his feet - _with the
stretcher still tied to him_, and ran out of the ER and down the street.
He then noticed the flimsy restraints on his arms, and snapped them off with
a shrug. The stretcher fell away from him, and with another load roar, he
ran away, howling into the night.
"He's getting away! Somebody do something!" said a nurse.
"Listen, if you think I'm going after him - you're crazy." said my partner.
"Don't look at me - you're just lucky he didn't think you were a bottle of
soda - with a twist-off top."
3) Still trying to take some pixs at calls - give me some time.
________________________________________________________________________
| Tae-Hyong Kim, NREMT-P, MICT e-mail: ST871622@pip.cc.brandeis.edu |
| Assistant Instructor Overheard during an autopsy: |
| Northeastern University Observer: Did he die of a cardiac arrest? |
| Paramedic Program Coroner: Well, the baseball bat helped a bit.|
------------------------------------------------------------------------
: Keep the Faith, Louise who would love some medical-grade leather
: restraints
Tae, who would be happy to get a pair for you - only if he gets to apply them