It was a busy night, I had my dinner at 10:30 ->mutton fried rice.. Catch some sleep with q1h call from the ward. The Respiratory care ward nurse called me at 6:06 am telling me that there was a leak cuff and the patient was desaturating. I splashed my face with some cool water and took the lift(even though it was 3rd floor but I was too tired). As I entered the ward and took a quick glance at the patient; I decided to reintubate her stat. The nurses showed me that introducer and asked me if I need it. I was still in my twilight zone and told her that I would do a direct one(simple reason – the tube is definitely not in the trachea as the patient was desaturating). When I removed the tube, I found that the patient was clenching her mouth very tightly and I was unable to introduce the blade, I started to wander if I had made a wrong judgement/decision at the time. I ordered 3cc of diprivan and proceeded with the trial by forcing the blade into the mouth. The attempts had leaded to bleeding of the gum and I found that there was a lot of granulation tissue around the gum.
I almost fainted when the nurse came back with the milky colour syringe in her hand but she also had a veno-cath in her hand. That means the patient had no parenteral line. Wow, now I had 2 problems, airway and venous assess……My fault as I had taken for granted that all patient laying in the respiratory care ward had a line. Well, blood had kept flowing out from the patient mouth while I bagged the patient…. I had to make a call of inserting a central line or try intubation… One of the nurses had run to the station and prepared for the central line insertion and I decided to take a chance to intubate again. I could barely insert the blade through the silt of tetanus-like clenching teeth but managed to get it. The best I could do was lifting the jaw up and exposing a window of slightly larger than 50sen coin. I saw the epiglottis though and decided to give a try…. I passed the tube into the mouth and did a slight adjustment of the curve(bad practice as you would have to contact the tube with the oral mucosa) – curving it into a U shape. I sighed when I noticed fogging in the tube as I passed the tube along. I had a feeling that my right index finger was bitten as I felt pain during the trial (bitten of coz…) and I was right, I noticed some blood in the glove and there was a shallow wound over the middle phalange upon examination. I did not bother with the tetanus injection as I got shot 5 years ago but true reason was I darn hate neddle....Well, the rest was simple – securing the tube, inserting a central line and packing the bleeding of the gum after sedating the patient.
The nurses had told me that the patient was lucky that I was on call or else the scenario would take extra times and messy… I grinned and told them that the patient times was not up yet, but deep in side me- I considered it was an act of god through my hand….. Had my skill become better ? I don’t think so but I think faith is the key to the success….
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