Code
Walked right into a code today. It's a patient I don't know and night float intern was telling me a little about how she got hypoxic/not getting in enough oxygen. I needed to relieve the night intern and so I just asked him to go. Waited around until Pulmonary critical care team arrived and when they did, they started gowning up and wearing a mask. I did the same even though I thought it was overkill. Oh man, I couldn't be more wrong.
So these are BMT patients meaning most of them have platelets of <5. In comparison, you and I have platelets in the 200s. Platelets help you clot so that means that these patients can start bleeding spontaneously. And they do. So she started getting hypoxic cuz she was bleeding in her lungs and forming a clot. So she wasn't getting enough oxygen to her lungs.
Anyways, so the team came and I asked if I could do the intubation. The fellow said not this time cuz she was really unstable. She was running strings of PVCs sometimes. And that is NOT good. But I positioned myself at the head of the bed anyways to see. The fellow shoved the blade down her throat and all she saw was a pool of blood. The suction was not working right at all and suddenly, as we were trying to put the tube down her throat, a whole rush of blood came up her mouth and covered all of her face and soaked through everything. We suctioned as best as we could and tried to put in the tube again. As soon as we wiped away the first pool of blood, a second one came up. There were clots that needed to be cleared out by hand cuz the suction wasn't working. I have never seen that much of blood in my life!
Finally, we were able to put in the tube to start breathing for her and she was wheeled away to the ICU. I stayed on the floor and didn't see her again later. They tried a bronch on her at bedside when she threw up blood again. She had a cardiac arrest but was brought back with CPR and defibrillation and was sent to the OR to have her blood vessels embolized to stop the bleeding. She finally died after all of that. It was not a pleasant death.
-kneige-
So these are BMT patients meaning most of them have platelets of <5. In comparison, you and I have platelets in the 200s. Platelets help you clot so that means that these patients can start bleeding spontaneously. And they do. So she started getting hypoxic cuz she was bleeding in her lungs and forming a clot. So she wasn't getting enough oxygen to her lungs.
Anyways, so the team came and I asked if I could do the intubation. The fellow said not this time cuz she was really unstable. She was running strings of PVCs sometimes. And that is NOT good. But I positioned myself at the head of the bed anyways to see. The fellow shoved the blade down her throat and all she saw was a pool of blood. The suction was not working right at all and suddenly, as we were trying to put the tube down her throat, a whole rush of blood came up her mouth and covered all of her face and soaked through everything. We suctioned as best as we could and tried to put in the tube again. As soon as we wiped away the first pool of blood, a second one came up. There were clots that needed to be cleared out by hand cuz the suction wasn't working. I have never seen that much of blood in my life!
Finally, we were able to put in the tube to start breathing for her and she was wheeled away to the ICU. I stayed on the floor and didn't see her again later. They tried a bronch on her at bedside when she threw up blood again. She had a cardiac arrest but was brought back with CPR and defibrillation and was sent to the OR to have her blood vessels embolized to stop the bleeding. She finally died after all of that. It was not a pleasant death.
-kneige-