Page 17 of Dr. Alaska
Lee studied the cardiac monitor pattern for ten seconds. “Still V-fib. Continue compressions and let’s give one milligram of epi.” Lee turned to the HUC. “Please tell me when it’s been three minutes, and we will repeat the epi dose.”
Deirdre grabbed the brown medication box from the CPR cart, opened it, flicked the caps off the vial and syringe at the same time with both thumbs, shoved the vial into the syringe, then injected epi through the IV port.
Lee’s response to stressful situations was objective and measured—going to pieces could wait for later. She pulled up the ACLS algorithm on her phone. “Continue compressions for two minutes.” She confirmed that a bag of IV fluid ran at a wide-open rate. Unlikely to be volume depletion, but that was an easy diagnosis to treat, and the fluids might improve blood pressure.
Deirdre and another staff member slid a hard plastic piece under Bruce’s back as Amberlyn continued her CPR efforts. In less than a minute, they had the Lucas automatic compression device set up and chunking out high quality, regular chest compressions. Panting, Amberlyn wiped sweat from her forehead, stepped away from the bed, and tucked the stepstool into the corner of the room.
Lee had less than two minutes to think during each CPR cycle. What came next? It had been several years since her training, and even then, the residents had in-house critical care, hospitalist, or emergency department docs to supervise codes. Lee had paid close attention and kept up her certifications, but Lordie, this situation stretched well beyond her comfort zone.
She squeezed her grip on the plastic footboard. “All right. Let’s get an advanced airway. You up for it, Clyde?”
He eyeshot her a wide-eyed expression and gave a curt shake of his head. “Out of my scope of license. What about the CRNA?”
No one answered. Lee’s palms got sweaty. The CRNA hadn’t arrived yet. Criminelly. How long had it been since she had intubated an adult? Stiffening her spine, Lee covertly scrolled on her ACLS steps so she could select endotracheal tube and laryngoscope blade sizes without floundering.
She would have to do this herself. Okay, then.
“Anyone want some help?” a familiar low voice carried through the murmurs, telemetry beeps, and relentless grindingchunksof the pistoning Lucas device. Maverick filled the doorway, beanie and coat on, paramedic kit over his shoulder. Louise hovered next to him, dark brown eyebrows raised.
“Yes!” Lee and Deirdre said in unison. No idea how Maverick and Louise managed to be here, but in Lee’s universe, the more qualified help she had, the better.
Maverick flashed a quick grin, looked down at Bruce, then shook his head. “For the record, he was fine when Louise and I dropped him off.”
Deirdre glared daggers at her brother.
He raised his hands. “Oof. Tough crowd.” He set the paramedic bag on the floor and opened it, shrugged out of his coat and hat, snapped on gloves, then unwrapped one end of the endotracheal tube sterile packaging and laid it next to Bruce’s head on the bed. He pulled out a laryngoscope blade and snapped it open on the handle, making the blade’s bright light shine. “Move that way for a second, Clyde.”
“Two minutes,” the HUC spoke up.
“Stop compressions,” Lee said, studying the monitor for a few seconds. “V-fib. Charge to one hundred fifty joules.”
Deirdre pressed the button to charge the defibrillator, the high-pitched whine of the machine ratcheting up the stress level in the room.
“I’m clear. You’re clear. Everyone’s clear,” Lee said. She double-checked that the metal laryngoscope Maverick held in his hand didn’t touch the bed. “Shock.”
Deirdre pressed the button, and Bruce’s body jumped again.
After another few seconds, the monitors resumed the loud, wild alarms. “V-fib.” Lee stared at the monitor.Damn it.“Pulse?”
Clyde checked. “Not palpable.” He continued bag-mask ventilation.
Her mind spun.Focus on the ACLS steps. “Resume compressions.”
Amberlyn restarted the Lucas, and the device’s thickchunkingprovided strange percussion to the high-pitched beeps from the telemetry machine.
“You good to intubate, Maverick?”
“Almost, Doc.” He crouched, then picked up the laryngoscope.
“Three minutes, doctor,” the HUC called out.
“Push another milligram of epi.” Lee glanced at her phone. “Also, mark it so I remember to give three hundred milligrams of amiodarone IV in two minutes.”
“Epi is in,” Deirdre announced. “Pulling up three hundred milligrams of amiodarone to have ready.”
The Lucas machine continued chugging away. Lee’s clenched jaw ached as she scooted around the bed, standing near Bruce’s chest and ready to take additional action if needed.
Maverick’s broad shoulders rose and fell once, twice. Then he braced his legs wide, bent down, and slid in the laryngoscope blade to move Bruce’s tongue out of the way and lift the jaw. The only sound in the room was erratic, blaring alarms and thechunk-chunkbeat.
