I got another day off today! I slept in and went to enjoy the Bering Tea Coffee Shop, which is a wonderful place–see post.
But I was quickly called back to the hospital to see my patient, who was getting more and more severe symptoms of alcohol withdrawal. I talked with the on-call doctor who has been here for 25 years, and then I called the Internal Medicine doctor and the Critical Care doctor in Anchorage. We thought maybe if we increase his medications, we could control the withdrawal well enough. But through the day, he just got worse and worse. I had just left the hospital after increasing his meds to maximum doses. about a half an hour after I left, I got called back because he needed to be sedated and intubated and sent to Anchorage for ICU/critical care.
I went back to help intubate him. We do things differently here, and we have different resources available than what I’m used to. It was a difficult intubation–I tried a couple times, but I was unsuccessful. Then an EMT tried and he was also unsuccessful. By then the patient was having a lot of bleeding (too much alcohol with liver damage can make easy bleeding and can make the blood vessels bulge and bleed easily), and we couldn’t see his vocal cords, where to put in the breathing tube. For a while it was extremely tenuous situation with him not having a good airway, and with the bleeding it seemed impossible that we would be able to get a good airway. We got the needle cricothyroidotomy kit ready just in case (where we put a large hollow needle through the neck right into the airway and bypass the mouth and the branch off to the esophagus). The head doctor in charge of the medical staff came in, and he was able to put a breathing tube in by reaching down into his throat and feeling his vocal cords. Even then it took a while to reposition the breathing tube. Finally it was in right and we confirmed with chest x-ray. The patient’s oxygen saturation had been low for a bit, while we were trying to get a good airway.
Eventually we got a proper airway, and packaged him up to medevac him out to Anchorage. I hope he has another chance to live… for his wife and his young daughter.
Then I had to bring some extra supplies to the airplane that had gotten left behind in the rush, and I could not believe the wind. It was gusting at up to 60 miles per hour, whipping snow and sleet. I could hardly open the car door. then I got to the airport and saw the ambulance drive through the chain link fence and I ran out and ran through the fence (not exactly legal). But I couldn’t get any other way at this time of night. Anyway, the wind and snow were driving sideways in the wind. I had to lean into the wind. I can’t believe the team is flying in this weather. I hope and pray they make it safely to Anchorage.