You’re not all that fat, but still a tricky airway to manage; I knew you’d give me problems when your head dropped back in that heavy, final way. Your wife didn’t know you’d arrested, but she knew you were very, very sick. I shut the back doors, shaking my head apologeticaly – no, no, you guys drive to the hospital, there’s not a lot of room in here, we’re going to be very busy.
She doesn’t want to watch this. She may think she does. She really doesn’t.
Your face is slick with sweat and makes my hands slip over your cheeks and chin, just a hint of middle aged jowl pulling your face away from the mask, reducing the efficacy of the seal, blowing oxygen around your face rather than into your lungs. When I do push air into you, your chest rises and falls while your stomach rises and remains. I’m breathing for you, but your stomach is filling up rapidly.
You say “Urp.”
A sludgy tide of orange vomit crawls up into your mouth while I’m doing chest compressions; passive regurgitation, we call it. Not vomitting, just opening all the tubes and letting fluids and pressures find their own levels. Your mouth brims with the stuff and as the vehicle bumps over potholes, you slop like an over fill soup bowl in a ferry’s cafeteria. Vomit cascades out of your mouth, up your nose, into your eyes and hair.
I whack the suction up as high as it can go, hoover the goop out of your mouth and nose; momentarily fret about the state of you – live fast, die young…
The bag and mask still won’t push air in. It’s blocked by something, but your mouth is empty, your nose is clear.
I grab the response bag and pull out a laryngoscope with the longest blade I can find. The last time I did this was on a 64 year old man, with no teeth, having a laparoscopic cholecystectomy. I had two anaesthetists and an ODP watching me.
And the fucking bed and floor weren’t moving at the time.
Push the head into position, slide the blade down the right hand side and sweep the tongue, now lift…don’t lever on the teeth…lift, pull his neck towards the far corner of the room.
There. His larynx. Packed full of spew.
The suction catheter shimmies down along the laryngoscope blade and sooks the last of the gunk from his airway. His vocal cords wave at me, a fleshy “peace out” V shape, with darkness behind them.
You’d be such an easy intubation. I could shove a tube down there right now. It would secure your airway, you could vomit all you like and it wouldn’t matter a docken, I could concentrate on CPR, rather than clearing your throat of acrid lentil soup.
But you’re young. And you’re going to die. I’m realistic about this.
There will be a post-mortem. They’ll ask who intubated.
And the response will come back – “The unregistered paramedic in the ambulance.”
And I’ll be struck off before I’ve even practiced.
Sorry mate. There’ll be folk in my career who I’ll tube who AREN’T going to die. From the history your family gives me, your chances are terrible. I’m confident I know what stopped your heart today; I’ve never seen anyone survive this.
You’re a lost cause.
But I’m not.