Noxious Stimuli

He was in his 80s, chronically ill with something -- I don't recall exactly what -- and barely breathing.

The house was up in the hills, tucked back on a windy side street. My training officer drove while I looked at the Thomas Guide and the fire mapbook and the MDC and tried to make sense of the streets. As we pulled up behind the fire truck, we saw a firefighter run out, grab the suction unit, and run back in.

"Huh," I said. My training officer was less reserved.

"They're gonna tube someone. Let's get in there."

* * *

He was all the way in the back, on the bed, flat on his back. Gurgling respirations. Didn't respond to voice or painful stimuli. His son was there, visibly upset. A DNR was taped to the wall next to the bed. We explained to the son what the DNR meant. No mechanical ventilation, no intubation. No, no, the son said, the DNR is for the underlying condition, this is different, I want him helped, and I signed the DNR, I'm power of attorney!

My training officer pulled out his phone and called medical control. I suctioned him out, dropped an OPA in and started bagging. Not a twitch at the OPA. His sat was initially 68%. A few minutes of good assisted ventilations later, he was in the high 90s. BLS works.

The training officer came back in. Said the doc agreed that if the son signed the DNR, then he could waive it, and we should do what he wanted. The son asked what we thought needed to happen. We told him that his father needed a breathing tube inserted.

"Okay, are you good at doing that?" he asked nervously.

"It's what we do," my training officer said.

* * *

The fire guys passed me the stuff I'd need. A grandview blade on the scope, the first time I'd used one -- they work great on the mannequins, though, and why not? We moved him around, got a pillow under his head. I put the blade in, saw nothing but secretions. Suctioned. Looked again. Suctioned again. Saw the epiglottis, moved the tip of the blade towards it ...

The training officer tapped my shoulder. "Uh, he's looking at you."

I looked straight down. The man's eyes were open. He started to close his mouth on the blade. I yanked it out like it was electrified.

"Whoa there."

"I guess," the firemedic said wryly, "he just needed a more noxious stimulus."

* * *

We took him to the hospital without lights and sirens, a nasal airway in place, bagging him. Probably a stroke. It seemed like a laryngoscope blade in the throat was the level of stimuli he needed to wake up, but less noxious stimuli did help.

Ten seconds more and I would have had the tube, but in the end BLS airway management kept his sats up and seemed to get the job done. Never heard about an outcome.

* * *

Working Christmas Eve, Christmas day, New Year's Eve, New Year's day. Probably be some stories come out of that. Also some interesting developments with the wilderness ALS unit -- more on that depending on what happens.

Oh, and so far my white cloud is winning.