Respiratory Therapy 101: Just Keep Breathing

Alright. I know that this is bad, but I have to tell this story.

Today I was working in the ER. I was on my way to draw a blood gas when the phone rang. I grumbled obscenities as it rang: the damn thing had been driving me nuts all day.

“Respiratory.”

“Um, hi. Just got a call from Scumble County EMS. There’s a code on the way in, eight minutes. We’re putting it in the trauma room.” I looked across the room and saw the front desk secretary waving frantically at me as she spoke into the phone.

“Oh. Well, thanks for the warning!” I waved back and hung up the phone. Eight minutes is plenty of time. I ambled towards the trauma bay at the front of the ER, taking my sweet time and pondering the code to come. Just as I walked by the ER doors, they slid open and three Scumble County EMTs sped in, pounding a young mans chest and scattering passers-by and me to the wind. Apparently SCEMS has added a new Warp Speed feature to their trucks…better too soon than too late I suppose.

I pulled myself together and skittered into the Trauma Room. Following the unspoken rule of RTs everywhere, I went to the head of the bed and relieved the paramedic who was bagging the patient. Incidentally I don’t know why it is that we RTs always do this to medics, many of whom seem to enjoy staying at the code; but I suspect it has something to do with ancient territorial instincts.  I eyeballed the patient: young, muscular, covered in vaguely religious tattoos: stars of David, Christian crosses, teary-eyed Jesuses and so on. He had apparently suffocated himself to death. The handy-dandy EMT student was doing some excellent compressions, and I bagged as the medics reported.

“25 year old man found down in his home by his father, who cut him down and called us. When we got there he was pulseless and apneic. Asystole on the monitor all the way from there to here.” The ER doctor nodded.  “How long would you say his downtime was?” he asked.

“At least forty minutes. That’s how long we’ve been working him, and he was down before we got there. We’ve given three epi, three atropine, two of Bicarb, CPR all in between. Easy airway, good lung sounds.” The doc nodded and complimented EMS on their airway, after which he stared at us as we compressed the young man’s chest.

“Give him one more round of epinephrine and one of bicarb and then we’ll call him.” The rounds were given, the code was called. I pulled the ambu off of the ET tube, the EMT student stepped down from his stool and wiped the sweat from his brow. At this point I looked over the patient one more time. He was covered in body art. Intrigued by his cryptic tattoo sensibilities, perhaps hoping to get a sense of who this dead young man was, I examined them closer.

Amid his religious tattoos, between the Star of David and the giant glowing crucifix, was a folded pair of praying hands, like this:

Right above the xiphoid process, on the sternum. Precisely where one would fold their hands to compress the chest during CPR. It was as if he had tattooed the BLS manual onto himself. Perhaps he saw this coming and wanted to leave clear instructions for his rescuers; perhaps he was unintentionally ironic. I found it delicious that the removal of the folded CPR hands revealed the folded prayer hands; effectively we went from one last-ditch effort to another.

I, for one, was deeply amused. An unexpected message from beyond the grave.