Maloney looked at the cardioscope screen: “Bigemini, Phil?”
“Yeah! Please… Stop the surgery!” Newman replaced the Propofol solution with a 5% dextrose-in-water bag. “Get the crash cart in the room, STAT! Bob: Call ‘CODE BLUE’!”
Newman removed the anesthesia screen and used his surgical mask to wipe his forehead before throwing it in a bucket. It‘s easy to forget important cardiopulmonary resuscitation steps when under pressure and Phil knew it. Usually, he only helped other doctors with their CPR’s and regularly trained on “Resuscianne”, the CPR teaching doll. But his own patient in cardiac distress? This was uncommon. Thank God for that brainwashing alphabetical training!
A for “AIRWAY.”
Inject a quick 100 mm of succynilcholine into the now wide-open IV tubing to paralyze the patient and allow tracheal intubation.
Phil ventilated the unresponsive, unconscious patient as well as he could with 100% oxygen by mask. As soon as the neck muscles stopped fasciculating, indicating that his jaw was relaxed, he opened his mouth to illuminate the vocal cords with the laryngoscope. Hastily, he introduced a number 8 cuffed endotracheal tube in the windpipe, and then quickly inflated the cuff with an air syringe to prevent leaks. After connecting the endotracheal tube to the anesthesia hoses, he now exposed the chest.
B for “BREATHING.”
Squeezing the black rubber anesthetic bag to force oxygen
into the lungs, Phil watched the satisfactory up and down movement of the chest and listened with his stethoscope to both lungs before turning on the automatic ventilator.
The massive stainless steel crash cart was now in the room. Peggy Kane, the 40-year-old OR supervisor, came in through a side door, Linda covered the unfinished surgery site with a sterile towel. Mask and gloves off, Jesse Maloney was ready to help. The bigeminal rhythm continued...beep, BEEP...beep, BEEP...beep, BEEP...
Phil injected 100 milligrams of 100% Lidocaine into the I.V. tubing and let the intravenous drip run fast again. Lidocaine is a local anesthetic which also has a calming effect on irritable heart muscles.
The automatic blood pressure machine showed a sudden drop: 72/48. Pulse 188, O2 saturation 72, lips getting bluish. Bad sign! He pushed the button again: 58 over nothing! Darn!
C for “CIRCULATION.”
“Start cardiac massage Jesse!” The pressure is going down to zero!”
“Drop the table Phil.”, Maloney replied.
Phil pressed the pedal at the OR table base with his right foot to lower it. Standing on the left side of the comatose patient, Maloney started pushing on his chest, right hand over left and counting: “one, one thousand...two, one thousand... three, one thousand...” to simulate a regular cardiac massage rhythm. After “five, one thousand,” he took a short break to allow Philip, who had gone back to manual ventilation, to inflate the lungs with oxygen. The counting restarted: “one, one thousand...two, one thousand...”
An electrocardioscope is useless when performing chest compressions. Newman knew the importance of checking the scope during respiratory pauses. In the beginning, the tracing simply indicated tachyarrhythmia, a rapid irregular heart. But now, after inspecting all the wires to make sure they were still connected, he was dismayed to observe a classical ventricular fibrillation pattern; his heartbeat and pulse were out of sync.
D for “DRUGS.”
“Bob! Epi and sodium bicarb. IV STAT!” The Marine veteran knew how to execute orders. He administered the ready-to-use medications within seconds. His calm assurance was almost unnatural. For someone who treated “blown-apart” soldiers in Vietnam, what’s an unexpected cardiac arrest?
E for “?”
What in the world does E stand for? Phil hesitated, but quickly remembered.
E for “ELECTROCARDIOGRAM.”