Thursday, November 25, 2010


Trachs are nasty things. I don't particularly care for them, but for someone who is facing longterm ventilation (anything greater than 10 days in my hospital) they are actually a good solution. They provide access to the lungs and a stable airway without damaging the cord and trachea. You can ventilate through them, and unlike endotracheal tubes, they don't come out as soon as you discontinue the vent. There is another weaning process you must go through to get rid of the trach. First they must be plugged for a period of time to see if a person can breathe through their upper airway. Sometimes this involves going to a smaller size trach before we start the plugging trials. The end result is to hopefully pull the trach out and have the human resume breathing through the mouth/nose area.

I pulled out a trach today. It was going well until I realized there were still some sutures in place. No wonder the guy looked like he was about to punch me in the face. Ouch. Eventually we worked out that minor detail and the guy got kicked out of the ICU and onto the floors. Seems to be doing fine.

Remember the guy who made me cry on Sunday night? I worked with his wife all day yesterday and today. I thought it might be a bit awkward, but she's super nice. The only thing that really got me was this:

  • I attended a delivery with RT who made me cry. I said I wasn't going to suction because the baby sounded fine, and I was pretty sure we tried not to do that if we didn't have to. He told me that was nonsense and we should suction every baby.
  • I attend a delivery today with RT's wife (also an RT). I asked if we should suction and she told me that that was silly, we are trying not to suction babies anymore. WTF. ARGH. Ok. So I don't, and then the baby is seriously not breathing and the laryngoscope is out and the tube is ready to go in and in walks the pediatrician who says STOP. He walks over, suctions the baby, who starts screaming and everything is fine.  
Also. Today was kind of a gong show. It started at 7:01 (1 minute after report finished) with a stat ABG. At 8:11 we intubated this person who was in Status Epilepticus. At 9:00 we intubated a very old man whose code status is NO CPR, but intubation is ok. Sigh. Life doesn't make sense. And on and on it went. 

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