No-So-Calm Before the Storm

Storm clouds were gathering that day, a typical occurrence for Virginia summers. The weather man was calling for possible severe storms. Doesn’t take a genius to figure that one out, just go outside and look up, duh. We were running a stacked medic unit that day, me, Wayne, Tess (who just passed her national registry paramedic exam!), and Scheila (a veteran medic and our department’s training coordinator who was getting some time on the unit with us). Notice Chris is not on the roster, and remember what happened last time he left me in charge of the unit? (See posting titled “Marines Rock!”) The call was for a choking. Typically the choking part is over by the time we get there and the patient just needs to be checked out. Not this time.

En route, we find out the patient is a 2 year old choking on a hot dog, and instructions were being given by phone on how to remove a foreign body from the airway. Now it’s time to change gears. Approaching the scene we see a large group of people in the area, apparently there was a barbecue going on in the neighborhood. A woman (the patient’s mom) rushes over with a limp, barely breathing child in her arms and hands him to one of the guys on the engine who promptly turns and rushes the child into the back of the ambulance while doing back blows to try and dislodge the hot dog. Unfortunately, while this was happening on one side of the unit, I had gotten out of the other side, grabbed bags and was headed towards the group. One of the medics I was working with that day yelled to me that the patient was coming to us, so I turned around, but not before 4 or 5 of the patient’s family members had gotten in front of me and were piling into the back of the ambulance. So while 3 members of the engine crew and the other 2 medics with me that day were beginning care for our patient, I was trying to remove all non-EMS personnel from my unit. Anyone who has run a serious call like this knows that you don’t need family in the back with you while you work on your patient. Family members don’t need to see what we need to do to save their loved one’s life, and in addition to being an emotional mess and therefore a distraction to us, sometimes family can interfere with patient care. It’s hard enough to focus on all the details of our work without a parent getting in the way or arguing with us about what we’re doing. So bottom line, tickets for the back of my unit are reserved for my crew and my patient only.

Once I was able to get into the unit I could see that the crew was busy; being aggressive in cases of airway compromise are key to being effective in our interventions. This poor kid was in a bad way. He was limp and listless, skin had taken on an ominous grayish color with blue creeping in around the lips. His breathing was coming in short, gasping breaths which were slowing down. The BVM was in place and we were ventilating, but could tell there was an obstruction. Out came the laryngoscope to get a better look. The airway was full of sputum and blood. Apparently the frightened mother had gotten a little carried away trying to do a finger sweep and remove the hot dog before we got there, and based on the amount of trauma in this kid’s mouth and throat I’m betting she had some serious finger nails. Suction cleared most of the blood and revealed a good sized chunk of hot dog almost completely blocking the child’s airway. The problem was compounded by the fact that it was lodged behind the epiglottis in the opening of the trachea. It was too big to fall completely into the trachea (thank God), but it was big enough to block the opening and the epiglottis was holding it firmly in place. That explains why the back blows we did were ineffective. Spontaneous breathing had all but stopped and the child’s oxygen level was in the low 80’s and falling. Scheila grabbed the Magill forceps and went after the hot dog. At first only a small piece broke off, but on the second try the rest came out. We immediately got O2 back on the patient and bagged aggressively. Then we heard one of the most wonderful sounds a medic can hear when dealing with a non-breathing child – crying. Yes! Crying means we’re moving air. Crying means breathing. “Wayne! Fast but smooth, GO!” I yelled through the window. Within a minute the gray color was being replaced by a pleasant pink and our patient was breathing on his own.

The low rumble of thunder was audible in the distance as we pulled onto the road and Wayne lit up the siren and stomped the gas. At this point I got on the horn to the ED to give them the heads up. Our patient was still breathing adequately, the crying was decreasing and he appeared sleepy which wasn’t too worrisome considering what he’d just been through, I’d be exhausted too! We roll into the ED a mere 7 minutes after marking on scene. Hey look, there’s Chris! He had been listening to the radio traffic and came up to the hospital POV to meet us. Chris had gotten there ahead of us and gave a heads-up to a nurse outside the ED. Upon hearing that we were rolling their way with a pediatric patient with an obstructed airway, the nurse sprang up and asked if we had called in to notify the ED yet. Chris assured her that we would if we hadn’t already, he was just trying to give them as much warning as possible. About that time our sirens could be heard approaching the hospital. The MD, respiratory therapist and nurses took over as we gave report. We also gave them the offending hot dog piece (.

A sigh of relief and high fives all around. There is no doubt that this child is alive today because of EMS. This was definitely one of those calls that reminds you why we do what we do. We all took a minute to decompress and then started cleaning and re-stocking. Life saved, job done. Well, not exactly…

The rumble in my tummy was second only to the thunder as I remembered that before this call we had been making dinner plans. The crew had decided to splurge tonight and order dinner from Outback Steakhouse, and Chris walked outside the ED so he could get a cell signal and call the station to start coordinating food orders. A staff member outside pointed to the lighted helipad and said to Chris, “They’re flying your kid.” “What?!? He was stable, what happened?” Chris asked. She told him that the patient had gone unconscious and his vitals were deteriorating, the ED charge nurse was waiting for a call from the helicopter service to see if they were flying. Chris looked up at the darkening skies and doubted that any helicopter could fly. As it turned out, the services to the north were experiencing a downpour and could not take off. One of the services to the south was pinned between two storms and couldn’t fly. The other service to the south had still not called back yet. The charge nurse was hopeful though, the pilots of this particular service are mostly retired military, specifically Vietnam combat chopper pilots who fly under most any conditions. Chris returned to the EMS room to give us the update.

And you thought the story was over…. stay tuned, there’s more to come.
- MedicCat