Friday, July 01, 2011


I have never met him -- will never meet him, not really -- and yet he still gives me a gift, in an odd way. Maybe not intentionally, certainly not knowingly, but a gift nonetheless. It's not even really a gift for me; just one for me to hold for a while -- I don't know how long -- until I find the ultimate recipient.

* * * *

It's a long drive, and the fire department EMTs have been there for a while when we arrive.

They're still doing CPR.

My partner heads for the monitor and asks the firefighter what she's got for access and what drugs they've given.

I sling the heavy green canvas airway bag at the foot of the staircase, and lean over the firefighter squeezing the BVM. He's got the mask clamped over the patient's face. A crumpled King airway lies on the floor.

"Hm," I say, almost to myself. The red-and-black intubation roll is already coming out of the airway kit. "King didn't work?" I ask the fireman - a good EMT who is in paramedic school - and he shakes his head.

"Nah, man, it just wouldn't advance."

Hm, indeed.

It takes me maybe ninety seconds to get everything together, and then I edge in. Slip the largyngoscope in his mouth, no, no, keep doing CPR, that's fine, aaaand --


I see why they had trouble with the King, and why I will have trouble with the tube. I can barely reach his epiglottis with the tip of the Mac 4, and I certainly can't see the cords.

In a second, I know what I have to do. I just wish I'd practiced it more.

I pull the blade out and turn back to my kit. "Bag him," I tell the confused fireman.

"You're not even going to try?" he asks, wondering why I never asked for the tube.

"Nope," I say, unscrewing the cap on a short length of PVC pipe in the bottom of the kit. "Not with that."

The bougie is a long, flexible plastic rod, a couple millimeters across. I slide an ET tube onto it, making sure I have a good eight inches of bougie below the end of the tube. A quick swap for the long Miller blade, and I'm back in the mouth.

Wait - yeah - there. I can just see the bottom of the cords. I hold up my hand, and the fireman carefully passes me the loaded tube. I fish the bougie down until I see it go between the goalposts, and as the fireman holds the top I can slide the tube in ...

* * * *

Of course it doesn't really matter, other than confirming a dismal end-tidal CO2, for the man is dead, and has been dead for some time now. All we are doing is confirming that he is really, exceptionally dead. I never met the man.

So why does it matter?

If we are not challenged, we don't grow. To be challenged by another, to be placed in a position where we have no choice but to stretch our capabilities or risk failure -- that is a gift.

I rarely use a bougie, because it's rarely necessary, and so I am thankful for the unknowing gift of a dead man, who pushed me to use this tool -- because someday there will be someone who isn't dead, who desperately needs an airway, and the bougie is going to let me put it there.


Ellie said...

Impovise, adapt, and overcome. But more importantly, know the contents of your toolkit. Well done!

Jen said...

From your experience, have you found this to be accurate?
Is this inflammatory or do you see a upswing in Benzodiazepine drug related admissions?
Love visiting your blog and your perspective of life in the truck with lights is awesome. Thanks for posting.

Drew Rinella said...

We get so few intubations here, I use a bougie everytime now. Why not, you know? They're a whole six bucks. Great post! I hope lots of people read it and remember this great tool.