Respiratory Therapy 101: Just Keep Breathing

I was standing around the ICU in a daze this morning. It was barely past 8, and the coffee had yet to fully hit my bloodstream and give me the extra zip to do my rounds in anything but a slackery manner. It gradually dawned on me that there were many other people standing around with me. Like me, many of them had clipboards and appeared somewhat glassy-eyed. A droning noise in the background gradually resolved into somebody’s voice.

“…so later on we’re going to take him to CT scan and see what’s going on with his brain.” A tiny blonde nurse was telling the tale of one of her patients, a cranial bleed who was looking unwell. A supervisory person in a labcoat nodded attentively.

“Does respiratory know about the transport? He’s on a vent.” The mention of my department woke me up a bit more.

“I guess I do now, yeah.” The crowd nodded at me and then moved on to another room, leaving me leaning back on a counter with my clipboard held out before me. A transport, I thought. Those are always fun. I made a mental note to look for a transport vent (we use the Pneuton) and then stretched out and began my rounds.

The day flew by. All of my patients were a little crazy, and all of them were a little busy: q4 treatments and chest PT, a couple of old alcoholics, a demented brain injury guy, and two of those tracheotomy patients who have a rabbit-like air of fear and anxiety about them at all times. Add to the mix some equally crazy family members, a wildly unsuccessful cardioversion, and my being spread between two units and you can get a sense of how quickly the five o’clock world approaches.

It was four forty-five and I was in the surgical ICU lending a hand to another therapist when my phone rang.

“Respiratory.”

“Hey, it’s Blonde Nurse. CT scan just called us and they’re ready for us to come down…can you go on the transport?” Aw, crap, I thought. I forgot all about that!

“I’m kind of busy. Have you seen my partner in crime lately?” The angry obese woman I was treating shifted her eyes and glared at me for using a nasty word like “crime.”

“I just asked him but I guess he’s expecting a floor transfer soon. I need somebody, I can’t take him by myself!” The nurse sounded agitated, and having long ago learned never to agitate a nurse if it can be avoided (note to AJC: Irwin is a noteworthy exception as he is permanently agitated.) I agreed to head over and transport with her.

I managed to get the Pneuton assembled and ready and be in the room within five minutes of being called. By an astonishing chance, that put me there way ahead of the patient transporters, who were apparently climbing a mountain in Bangladesh judging by the time it took them to come. We hooked the patient up, I grabbed the ambu-bag and off we went, clattering and clunking through the halls. As is the fate of any RT on a transport, I was smashed into many walls and doors because of the awkwardness of bagging while walking beside a too-wide bed in a too-narrow hall. They really should just let us “code surf” all the time…

…Anyway, we arrived at Radiology in short order. The patient seemed to be holding up just fine, but when Blonde Nurse went in to tell Radiology that we had arrived they looked at her as if she was from mars. As I stood in the hall and bagged, I could hear the sounds of Blonde Nurse tearing into one of the CT technicians as they argued about who called whom and who was not waiting in line. Something seemed amiss. I looked at the patient, and he seemed to be in pain. His face was beet-colored. His eyes watered. His respirations were increasing. Blonde Nurse came back and spoke to me.

“I don’t really like the way that he looks, dude.”

“You know, Blonde Nurse, I don’t really like the look of him either.” We decided that our emergency beat whatever it was that radiology was doing, and so we burst into an empty room and set up the transport vent and some suction. Blonde Nurse checked the patients monitor, and screamed. “Fuck! He’s infarcting!” I glanced at the screen and saw the telltale signs of myocardial doom. I began to bag a little deeper and faster. Blonde Nurse made a command decision. “The hell with the CT scan, we’re going back upstairs!” I nodded in agreement with her. “A CT’s no good to a dead man. Let’s roll.” We pushed out of radiology and began hustling back up the hall to the ICUs, much to the confusion of the already confused rad techs.

It was in the elevator that things began to go wrong. The patient, who was drooling a lot, managed to cause his ET tube tape to slip. With one sudden motion, the tube came out by a few centimeters and I heard a cough. Oh shit. I lunged for the tube and crammed it back into the patients throat, holding on to it for dear life and refusing to let go. The patient began looking much more purple in color. I bagged faster. He still had chest rise and the bag felt about the same as before, and I looked skyward and begged for assistance as we flew down the hall and burst into the unit in a flurry. Within seconds a gaggle of nurses and others had descended upon us. In the midst of emergenct EKGs and medication administrations, I found myself trying to retape an ET tube that was already slick from gallons of mucous.

Much to my gratitude, an RN/RT stepped in and assisted me at this point. From here, things improved: the patient stabilized, the tube stayed in, and everybody lived more or less happily ever after…

…except for the poor patient, who is to be terminally extubated in a few days. “Excitingly Futile” might describe this day better than anything else.