Lessons learned.

Lesson #1- ALWAYS have that bougie out and ready! Lesson #2- Cric pressure is your best friend. Lesson #3- Suction, suction, suction.

I wake with a start when the red light in my bedroom flicks on and the tones blare from the overhead speaker.

“Medic 22 with Medic 11, upgraded ALS response for a traumatic fall…”

I hop from my warm bunk and stuff my feet into my still warm boots and walk out to the bay and climb in the medic unit. I settle in the back and put on my headset. The captain turns to look at me through the pass through.” This is for you, ya know. 11s doesn’t need the help, but they know we have a student so they called us in.”

As we speed down the quiet streets, the radio mutters updates in my headset. “Bagging the patient.” “We need your C-Spine gear.”

We show up to a mess. The patient is a 50ish year old guy who had either been assaulted or had a standing ground level fall. Either way, it doesn’t matter. He’s in bad shape. A mushy occipital fracture, decorticate posturing and an airway full of blood means he is getting a tube.

The medic on scene finished starting the IV, lookes up at me and asks, “Can you go set up my truck to RSI this guy?”
“He looks to be around 150 pounds?” I guess.
“Sounds about right.”

The firefighters get to work packaging the guy on a board while I run over to Medic 11 and grab the intubation roll. I set out a 7.5, a mac 3, and  pull the bougie from the airway cabinet and lay it within reach on the bench. Then I start drawing up the drugs. 140mg of Sux, 20 of Etomidate, the Vec, the Versed. I label all of the syringes and carefully place them in order on the counter next to the head of the stretcher. Suction? Set. Vent is out and plugged in. I am as ready as I’ll ever be.
The stretcher comes crashing and rolling into the back of the rig. The Captain is bagging, the guy is seizing. A firefighter I don’t know is holding the man’s arms to keep him from pulling the mask from his ruined face. 11′s medic asks me to get a BP as he pushes some benzos. As I pump up up the cuff I hear the medic tell my preceptor, “No, you can go, I’ll just take your student.”
Monitor on, pulse ox, capnography showing a good waveform.
Down the road we go. Blood everywhere. The suction thrums, slurping in the guy’s mouth.

The medic asks if I think I can get the tube. I tell him I’d give it a shot.
“This is going to be a hard one,” he says. “He’s got a bunch of facial trauma, his airway is full of blood, he’s in a C-collar…” He trails off, looking at me expectantly.
“Well, no time like the present,” I say.

He smiles as he pushes the Etomidate and Sux while I pick up the laryngoscope in my left hand.