Friday, September 27, 2013

Dr. Vandyk had developed a very bad habit, besides his constant smoking. In the event that he had to intubate a person, he would not wait to have an Ambu bag attached to see if the tube was correctly in place, he would use his mouth to blow into the tube to watch for the chest to rise. It was a very bad habit.
An elderly, obese woman arrested in the emergency department. She had presented with the complaint of chest tightness. We had started an I. V. and done an EKG when she gasped, clutched her chest, and her monitor went asystole. Asystole means her heart stopped. For whatever reason, the electrical impulses which cause the heart to beat weren’t being transmitted.
Her bed was right next to a crash cart. Dr. Vandyk yanked open the intubation drawer and pulled out a laryngoscope. He opened her mouth and asked for a 6.5 mm endo-tube. Dr. Vandyk slid the scope into her mouth and inserted the endotracheal tube. Not waiting for the balloon of the tube to be inflated, he leaned over and blew into the tube.
I thought I saw the woman’s abdomen move. If the tube is in the esophagus instead of the trachea, air will enter the stomach and not the lungs. The nurse listening shook her head. I placed my hand on her abdomen to see if I could feel her belly move as the doctor attempted to intubate a second time.
He slid the tube down her throat. Dr. Vandyk leaned over for a second breath, before he could blow the second time, I felt the abdomen move. I tried to warn the doctor, but all I could get out of my mouth was “Doc….” before an eruption of stomach contents poured out through the tube. It went right into the doctor’s open mouth. He leaned to the side of the bed and spat onto the floor the woman’s stomach contents.
He spat a few more times saying “Fish!” Pfttt! “Fish!”
You’d have thought this incident would have changed this habit, but it didn’t. Nasty as this incident was, it was not enough to change his habits.

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