Shanksteps #107
I’m being shaken awake by my wife. “Wake up, get up”. It was 11PM. I had just fallen into a deep sleep. i hadn’t heard the knock on the window. She had, and had gone into the hospital, finding a 10 month old who’s breathing could be heard outside the building. “Come in to the hospital, I think we need to do a tracheostomy”. Well that got my attention. I don’t have equipment for tracheostomies except a few sizes in adults. This was a 10 months old. She had apparently taken some rice grains
and tried to eat them but inhaled them instead, five days before. Since that moment she had breathed terribly and now was much worse. I crawl into cloths acceptable for the hospital and walk into the ER with Audrey. A small girl is breathing about 50 times a minute. At every breath her small chest is retracting and all extra musculature is helping her to breath making a LOUD wheezing sound at each shallow breath. she will not last long like this, I agreed. It IS necessary. We had been up since
three the previous morning and were still groggy. We quickly took him off oxygen and headed to the OR calling for the nurse to come do the Ketamine anesthesia. She dropped her oxygen rapidly during the transfer to the next building. The oxygen was replaced and the respirations again dropped from 70 to 50 (a slight improvement, but still very bad). I selected an endotrachial tube to modify and place as a tracheostomy. The girls neck was opened above the sternum. We slowly dissected down, attempting
to make this as bloodless as possible, so as not to drowned the trachea when we opened it. We made a “U” shaped incision in the trachea. Immediately, extensive coughing produced a significant volume of pus from the lungs. After suturing the tracheostomy open I performed a bronchoscopy. I aspirated pus from both lung bronchi. then I scoped upwards. It was difficult to see but something moved. Afterwards I examined the larynx. There lay a dislodged piece of rice. Everything was very inflammed
and edematous. I placed the modified tracheostomy tube into the trachea and sutured it in place. She was breathing normally at 16 breaths a minute.
After finishing my notes and placing the patient in her room with oxygen I headed towards home. I fell asleep dreaming of having a respiratory therapist. One and a half hours later I was awakened by “the knock”. She was breathing difficultly. I ran in, finding that the tube was nearly plugged with dried secretions. I suctioned them and she started breathing better. I told the nurse that if she was breathing badly or desaturating to call me. OR if it completely plugged and the patient was dying
to cut the sutures and remove the tube. I was called an hour later. It was plugged and he had cut the suture and pulled it out. I arrived to her breathing calmly without a tube.
Today was Sabbath and I have spent much of the day worrying about her and making sure this stays open. i pray that the swelling in her throat will go down rapidly so she can breath normally from above again. I’ve tried to sleep but it would not come. Wasted but unable to sleep, I continue to think of her. Lord help her live! In His Service, Greg