One Night With Her Boss

The unconscious driver was on a stretcher within a very short period of time, moved clear of the wreckage, but securing him in the helicopter was still some way off, it appeared. The man’s breathing was deteriorating and Tama clearly wanted to try and stabilise his condition prior to transport. He opened pockets of the Thomas pack and took out a large, tightly rolled package.

Mikki was using the stethoscope as Tama untied the package and opened it up to reveal an intubation kit. She nodded her agreement.

‘He’s got some bleeding going on in his trachea,’ she said. ‘And I don’t like this swelling in his neck. If we don’t secure his airway now, we might lose it completely.’

‘Absolutely.’ Tama was holding up a pair of gloves that looked far too small for his hands. ‘Go for it, Doc.’

Mikki couldn’t help her jaw dropping in astonishment.

Technically, she had higher qualifications than either of the paramedic air rescue crew. She had intubated dozens of people in emergency departments and Theatre but these guys had the huge advantage of experience in working under precisely these conditions.

Rescue crews were still busy around them. It was noisy and dirty and…foreign. And this was an obese patient who could be difficult to intubate even under ideal circumstances. Tama was throwing her in the deep end here but she had breezed through that cannulation, hadn’t she?

She could do this, too.

Except it was harder than she had feared. With blood in the airway and bright sunlight negating the effect of the laryngoscope’s light, it was impossible.

‘I can’t see a thing,’ Mikki had to admit.

‘Here. I’ll shade you.’ Tama loomed close over Mikki and the man’s head, blocking the light from falling directly on them.

Mikki still couldn’t visualise the vocal cords. It was hard to keep a note of desperation from her voice.

‘I need suction.’

‘It’s here.’ Tama managed to slip the handle of the suction unit inside their patient’s mouth without dislodging the laryngoscope Mikki held in place. She reached for an ET tube.

‘Here goes,’ she muttered hopefully.

Her first attempt failed.

‘Oxygen saturation is dropping.’ Josh was right beside her. ‘I’ll bag mask him for a sec.’

Mikki sat back on her heels, looking for a replacement tube in the kit. She caught Tama’s steady gaze. ‘Maybe you should do this,’ she suggested. Or Josh could. Except that Josh was now responding to a signal from a fire officer. It looked as though one of the rescue workers had injured himself.

‘Have another go,’ Tama directed.

So she did and again it proved impossible.

‘The trachea’s swelling,’ she said in despair. ‘I can’t get this past the cords even with a guide wire.’

‘I’ll have a go.’

They swapped places. Tama handed her the bag-mask unit and she held the mask over the man’s face, squeezing the bag to try and get a high concentration of oxygen into the man’s lungs. She could feel it becoming more difficult as the airway closed further. Tama was pulling on gloves. As he picked up the laryngoscope, Mikki could hear the deterioration in the man’s breathing. A nasty stridor that suggested they might be about to lose this challenge.

Tama positioned himself and the patient’s head. He inserted the laryngoscope.

‘Give me some cricoid pressure,’ he instructed seconds later.

Mikki pressed on an Adam’s apple that was actually hard to locate in an already thick neck that had severe swelling going on as well. If things were this hard from the outside, what hope did Tama have of slipping a tube through the airway internally?

Very little, but he managed. Almost instantly, he slipped the tube into place and then straightened to secure it and attach the bag mask to the end of the tube. Mikki picked up the unit as Tama placed his stethoscope on the chest. She squeezed the bag as he listened for lung sounds and then placed the disc below the ribs to exclude air going into the epigastrium.