Thereâs something new to learn every shift, even if itâs the smallest things, like the hidden entrance to that one nursing home you canât find because RescueTrack keeps sending you to the wrong side of the building. This Friday, I learned something a bit more frightening and less every day than that hidden entrance I spent twenty minutes searching before giving up and calling a colleague who talked me through finding it.
This Friday, I learned how to use suction on patients with a tracheostoma. I learned it, unfortunately and a bit in panic, on the back of the boo boo bus, frantically googling because I could see Iâd need it in another couple of minutes. âSure, itâll be grand,â theyâd told me at the hospital we fetched the patient at. âWeâve only had to use suction twice this morning, sure you wonât be needing to do it on a one-hour-drive,â said the nurse. âAnd if you do have to, just hold the trach and itâll be grand.â
Our patient had suffered a massive SAB and had had to be resuscitated at his home. Heâd got to the hospital with ROSC achieved, but his spleen had ruptured, his aorta dissected and he had several broken rips in a row. Also the docs had discovered a pulmonary embolism so he was on heparin. âJust so you know because his trach might bleed from the heparin, but no botherâ. Oh, and he was on 8litres of oxygen. âBut you do have a sat probe, donât you? So you can check his SpO2.â No, no we do not normally have that on the boo boo bus. Thatâs for the big sick ambulance. I had my personal one with me, by chance, though. Itâs not as accurate as the one attached to a Corpuls, but it would have to do.
The patient himself didnât do much of anything. His pupils were PEARRL, his right hand was moving without much aim or purpose or strength, but he couldnât fix his eyes on objects, couldnât communicate nor move otherwise. He did cough every now and again and the nurse had told us to watch the trach when he was because it might dislocate. Grand. Iâm thinking this is above my pay grade and frankly, the level of skill I was taught. Iâm not a paramedic (yet) and this isnât normally expected of RS (EMT).
So the inevitable happened purely because Iâm a shit magnet and half an hour later found me suctioning off sputum and phlegm from his trach while my colleague was driving through the hilly landscape of our home area to the other hospital. It did work, but I could have done without the panic and with a bit more of a non-trach environment for the second time ever I had to use suction in real life. Also someone other than a website for emergency services talking me through might have helped. Did you know you need too catheters for patients with a tracheostoma? One for the mouth and one for the tube protruding from his neck. And to take out the trach-tube in circling motions? Oh, and to wear glasses and a face mask because flying sputum and phlegm.
We arrived at the hospital with the patient stable and myself having dodged the projectile phlegm from his trach when heâd coughed, so everything was fine. Handover went grand, in my panic Iâd near-memorised the referral letter and my own observations. The nurses were ecstatic, as was the doc, initially. Except the hospital doesnât do heparin perfusors and when the doc heard, she was frantically calling her colleague in the original hospital to talk alternatives. That wasnât our problem anymore though, we went about cleaning the boo boo bus and then getting lunch and had a lovely time.
