I LOVE Respiratory Emergencies

Posted: May 6, 2013
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I love cats choking on huge hairballs, I love cyanotic laryngeal paralysis dogs, and nothing makes me happier than a GIANT sucking chest wound. I might actually knock you over to participate in thoracocentesis. I long for the day when there’s a patient on the ICU ventilator. I would rather draw an ABG than eat lunch. And I have been known to stay HOURS after my shift to run anesthesia on a thoracotomy. It’s a sickness. And working in emergency only makes it worse.

I’m not sure what it is about the respiratory system that is so thrilling for me – but I still stand gaping when the chest is open and the lungs are expanding. I’m mesmerized by arterial blood pulsing into a syringe. I do a happy dance (and usually exclaim ‘hot damn’ a little too loudly) when I successfully place an arterial catheter. I will give up my first love (sleep) to help out with a gnarly thoracic trauma, emergency thoracotomy or an ICU ventilator case. After 12 years, I have a few favorites that stand out.

1. The lab who impaled herself on a giant tree branch. It went from axilla to ingunal only impaling one lung lobe. This was in the days before iPhones and easy pictures and video, but I have a couple choice photos that I use to impress tech students and friends. I stayed late to monitor anesthesia for the thoracotomy portion of the surgery where we broke the stick into three pieces to remove it. Once the chest was closed and the abdominal approach started I passed it off to the next tech. The abdomen holds little excitement for me. The chest is where it’s at.

This dog presented to DoveLewis Emergency Animal Hospital with an actual stick poking out of her side. This image shows her before surgery with the stick in her chest, and the stick after removal.

2. Then there was the Border Collie who came in with a bilateral pyothorax. Chest tubes weren’t enough for him, and the decision was made to do a median sternotomy to clean and flush everything out. Um, yes please. I missed dinner and game night with friends to monitor that anesthesia and the sad thing is -- I didn’t think twice. It was fantastic and gross and exciting, as were the chest tube flushings for the next three days. I was in heaven.

3. Last year a little yorkie came rushing in after having a coyote chew on her chest. Bilateral sucking chest wounds. A flail chest to beat all flail chests. I was working in the ICU but was able to convince the surgery on-call tech to take my patients so I could run anesthesia. I have some AMAZING video of that dog pre-op. Awesome.

I’m a geeky cheerleader in the ICU when the ventilator comes out. The ICU doctor is usually a little apprehensive about getting all of the settings right, getting the patient hooked up, multiple CRIs running, tubes in and out of every orifice, dealing with the other 10 patients in ICU… I will run around with a big grin on my face telling them how much FUN this is – I suspect they secretly hate me at that moment.

My thoracic nerdiness is now well known – Dr. Richter will text me on a random night, “Getting ready to go in on a thorocotomy – jealous?” And then sends me some video of said thoracotomy patient. Or even better – photos of removed lung lobes or rib fractures. And I really am jealous. Like I said. Sickness. So if you know me well enough, be warned that I will include you in my sickness. I will text you photos and videos of lung lobes and flail chests. I will take pictures of my perfectly placed arterial lines and over-instrumented ventilator patients and want you to share in my excitement. Just smile and nod. I’m probably too excited to pay any attention to your response.