Popped His Cherry—Ben’s First Flight
We ended the night, in the early morning. All kinky implications aside. Ben and I crumpled into the grass outside the hanger gazing up at the stars hoping to catch a glimpse of part of the meteor showers. The night was cool, the sky clear but distant with the airport lights. We found the most protected area we could in the shadow of the fuel truck. Lying shoulder to shoulder quietly discussing the night.
I keep kidding him, asking if he really wants to go to CRNA school. The view out of my office window is far superior according to him. Until last night all he had to base that on was photos. Staring up at the sky, he now completely understood why I do what I do.
The call came in around 10 p.m. He showed up at the hanger to have dinner and ended up sitting next to me at 2,500 feet, circling an accident scene.
“19 year old male, pin-in with head and lower extremity injury,” was all we knew.
I broke into the RSI (rapid sequence intubation) kit, reviewing the cocktail and doses for sedation and paralyzation with the Flight Physician. Life is so much easier when I plop the drug bag open and can simply begin pushing drugs.
Fentanyl, Etomidate, Lidocaine, Succ, Norcuron. I handed Ben syringes and drug vials. He knew I was going to use his experience as a critical care nurse. I just don’t think he believed it would be that quickly. Labels on syringes. Order and doses written on my leg tape so I wouldn’t forget. I don’t remember if I don’t see it.
The landing zone wasn’t well defined. It is difficult to see flashlights marking the LZ when the rest of the local area is littered with fire, ambulance and police vehicles blinking and flashing. Ben had a grin from ear to ear. He had a better view out the window than I did. His heel kept bouncing in anticipation and excitement.
I handed Ben the portable pulse ox. It gave him a task to focus on, and one less thing for me to do. We exited the aircraft almost attached at the hip. I didn’t want to have to worry about him getting too far.
There are two types of scene calls. During the first, we take an active part in the extrication and packaging of the patient. We arrive early enough to help with the dirty work. The second type of scene flight we meet the medics and patient in the back of the ambulance. Normally, the ABC’s (airway, breathing and circulation) have been addressed. Airway controlled, bleeding stopped and IV’s established. That was the case with this flight.
Damn. I love a good extrication.
Regardless, Ben, the doc and I jumped in the back of the ambulance and were instantly accosted with a cussing, spitting drunk who was appropriately secured to a backboard, as much for his protection as ours.
Damn. I hate a bad drunk.
Nothing a bit of Fentanyl and Versed can’t cure. Especially since he was spitting blood. His face took the brunt of the collision.
Ben fought to get the pulse ox on and won. 99% on room air. Just what I wanted to see. 14 gauge in the crook of his arm. 16 gauge IV in his forearm. It is good to be a young trauma patient. Those garden hose veins are what I like to have to work with.
Well…apparently the Fentanyl and Versed worked a bit too well. We were going to intubate anyways.
RSI drugs ready, suction on, breathing tube and intubation equipment laid out in chaotic order. Patient’s breathing assisted by BVM (bag, valve mask).
“Lidocaine in at 2223. Pulse OX 99%.”
Without communication, doing an intubation can be tragic.
“Okay, ready for the rest,” the doc says.
I push the rest of the drugs, paralyzing and sedating the patient. He gets the tube, slick as can be. Ben spent the entire time on the patient’s right searching for equipment and being exposed to the art of intubation in the field.
We secured the tube after verifying placement by listening to lung sounds, using an end tidal CO2 detector, and listening over the epigastric area. With his airway secure, I finished doing my assessment. Nothing at the chest, belly soft, pelvis stable and limbs intact. Pulses were amazingly good.
I tossed Ben an OG (oral-gastric) tube. Nothing like sucking out a belly full of booze, but an important precaution nonetheless. Warned him that I was gonna use him! It is one thing to do nursing procedures in a controlled environment. It is another thing entirely to do them in the back of an ambulance, or in the dark by flashlight with a smashed up car teetering precariously above you.
The remainder of the flight went without incident. His vitals remained stable, but I think Ben was in Sinus Tach for at least the next 3 hours.
Hopefully this kid will be one of the lucky ones.