Emergent

As part of the intensive care team, I have to be ready to respond to emergencies and rapidly changing clinical situations in the hospital. The anesthesia residents carry the airway pager and respond to code blues. But even in the intensive care unit, our patients are so tenuous that emergencies arise daily. One patient who was recovering from a severe neurologic illness was becoming close to transferring out of the intensive care unit. He had been in the ICU for 2 weeks, most of that time on a ventilator. Because of a progressive disease that took out cranial nerves, he didn't have much of a gag reflex or a strong cough. Unfortunately, that put him at high risk for aspiration - choking on secetions. When we were called to bedside, he was hypoxic and minimally responsive. After mask-ventilating him to bring his oxygen up, we used a flexible fiberoptic bronchoscope to take a look and saw a lot of junk down one of the lungs. We decided to reintubate him and put him back on a mechanical ventilator. I then took a look with a bronchoscope to suction out the airways and do a bronchoalveolar lavage, testing for infectious organisms. Despite the hope of having the patient leave the unit, one small event set him back two weeks of recovery. This reminds me that even patients who seem to be doing well can easily have setbacks, whether from new infections, a blood clot from not moving, or deconditioning from prolonged illness. Although we hope for a smooth trajectory of recovery, patients often have a much more day-by-day progress-and-obstacle circuitous route to leaving the unit.