Thursday, January 28, 2010

Things That Make Me jack asses in the OR

I am back in the OR today for another run at some intubations. I woke up at 0550 in order to get myself together and be on time 0700. I arrived at 5min to 7 to find the place a tomb. No one was there. I found the charge nurse making coffee in the break room and she informed me that Thursdays always start at 0800. "I always ask if they are going to tell the students and they always say it would be too confusing". Too COMFUSING?! WTF?! We are learning how when and why to paralyze people, how when and why to shock people with electricity and how when and why to do nothing more than provide 02 for people. Coming in at 0800 on Thursday is beyond our simple medic brains? Jeeezus! Anyway, after getting over that I went to the atrium where there was a beautiful sunrise happening just outside the window. I had some coffee and did some homework. It was a pretty nice start to my day after all.

I made my way back down to the dungeon and looking at the schedule saw it was going to be a mostly LMA day. LMAs are an airway device that sits above the glottic opening and occludes (mostly) the esophagus allowing ventilation of the trachea and thus, lungs during surgery. They are mostly NOT used in EMS as they are not a definitive airway and they do not block the esophageal opening enough to prevent aspiration (at least not to the standard of most medical directors). They are however, quite popular for healthy pts having routine and short surgeries with the opportunity to fast beforehand to avoid vomiting and aspiration...and all the associated baddness. So, LMAs mean very few intubations.

On top of this there is a Life Flight RN in the OR today trying to get some tubes himself. There was a similar situation on Monday and Bernie and I worked it out. This guy today was a different story. A jack-ass, big, dumb, tube stealing, jerky themed story. I went to my first case and asked if Dr Scott, the doc I worked with last time who had been so wonderful to me, would allow me to shadow him and maybe assist. This is how I approach these guys. They don't want a tube whore they want a student. He told me he was going to LMA her and there wasn't really anything for me to do. I stood outside, waiting for my coffee to kick in and hoping something else might roll by. I heard the overhead pager "Lifting help to OR 6..." That was something I could help with. I walked back into the room and said "I can help lift". Dr Scott looked at me and said "You just earned yourself a tube." We moved the pt, I applied 02, then he put her under and I started preoxygenating her.
C-E seal and jaw lift as shown in this pic I pirated from the intertubes...I had her at 100% and had the doc happy with my technique. He told me to intubate and I took a look and thought I saw the cords and promptly tubed her stomach. Bummer. I was sure I was gone but nope. He told me to pull it out and get back in with the blade and show him my landmarks. This time I placed it and saw mist in the tube, equal bilateral chest rise and fall as well as a proper end tidal C02. I was in. He taught me how to tape and then we positioned her for her procedure. I was so high! I LOVE Dr Scott and I don't care who knows. He is my hero. My airway guru. Unfortunately, the next 2 cases he had in the day were going to be LMAs for sure as they were young healthy peeps with minor surgeries. Bummer!

I went on to find my other buddy Dr Pan. He had been quick to recognize me the other day and let me take a crack at the tube in the young woman with success. He was quiet but very nice and very helpful. I had seen him earlier but had not had the chance to ask about his cases. I was standing talking to the LF RN who had already been kicked out twice after missing 2 trys this morning, and I said "Oooh, I need to ask Dr Pan if I can get in on his late morning surgery, he's great." The charge RN came up to tell me something about tomorrow and the instant Dr Pan hung up the phone the LF RN went over and asked him if he could tube the late morning pt! What the FUCK!!!!!????? Pardon my french but the F word doesn't even begin to do justice to the horror of this dude's actions. What the hell kind of person does something like that?! What a shit head! Dr Pan of course, said yes. The LF RN smiled at me and I said "Nice, thanks" and walked away. There was nothing else to do. That was the last shot of the day. Fuck him! This means I got ONE tube today. I know that's better than none but c'mon! ONE after that bastard misses 2! and then steals mine?! I am pissed. He knew I am a student. I am not getting paid to be there I am paying to be there. He is on the clock! He only needed 2 tubes to be up to date. He will have had 4 tries if he can even make the next one. What a jack ass. I felt like saying a whole lot of "I hope you...." but wishing ill on other prehospital providers is bad mojo as far as I am concerned. When people are taking care of other people's lives you don't wish them ill. Especially since the Hubbs wants to fly some day. I just think it's poor form. So, I wish that someday really soon, he does something heroic. Something truly newsworthy...something that gets him on TV....maybe national news....and then I hope the butt of his flight suit rips....wide open.

Fitness day 42
I am down a true pant size! Woot Woot.
Water aerobics today again...
Also probably some weights. Feeling good. Love being at my own hospital so I can plan a work out before heading home. Makes things MUCH easier!

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