Ducking Under the Boom

On my first call in the medical ICU, the airway beeper gives a squeaky buzz just as the overhead paging system blares "Attention: Code Blue." We become hyperaware of these announcements; sometimes, just standing in the grocery store, I start looking around when I hear "Attention: Pears are 50% off." The code is in the cath lab. When I rush in, the cardiologists are in the middle of an angioplasty and stent for a middle aged gentleman with a heart attack. During the procedure, his blood pressures started tailing off and he vomited. He was not mentating well and needed to be intubated.

I quickly strapped on a lead vest since the cardiologists were using fluoro (real-time X-rays). The patient was on the cath table and the cardiologists were taking lots of images, which meant that the boom (in the nautical sense) was swinging around the patient. I quickly prepared my emergency airway equipment and medications. The cardiologists told us to intubate when ready, but they were not going to stop since they were in place to open up the blocked coronary vessel. Even with the boom flying about the top of the patient's head, I managed to secure the airway. Meanwhile, we started several vasopressor drips to keep his blood pressure up. During the case, there were several rounds of compressions when we'd lose the pulse, but eventually, the cardiologists managed to open up the clotted vessel and reperfuse the heart. The patient ended up doing well.

In comparison to the last code I wrote about, this one was quite different. Although we knew the problem in both cases (the last patient was bleeding, this patient had a heart attack), we were already poised to do the best intervention for this patient while we couldn't get control of the situation with the prior case. This was really a case in which we "saved" the patient's life.