Page 19 of Dr. Alaska
He gave her a sheepish grin. “Hey, I’m just a paramedic, not a fancy doctor, but it looks like normal sinus rhythm to me. Ow.” Maverick winced as Deirdre—carefully, since he was still providing ventilation—punched him in the arm. “What?”
Lee palpated Bruce’s carotid and felt the regular pulse. His chest rose and fell.
Her body felt boneless, and she exhaled. “Wow. Good job, everyone. Let’s run a post-arrest epinephrine drip at”—she sized him up and did a quick math calculation—“twenty-five micrograms per minute.”
Maverick’s sky-blue gaze at the head of the bed locked on to Lee. Her face tingled. Probably residual reaction due to stark fear for Bruce’s life. For what felt like way too long, she held still and studied Bruce.
Deirdre said, “Okay for me to remove the Lucas?”
“Yes, but… send it with transport?” Lee’s brain whirled while they took away the equipment and reattached EKG leads.
“No need. We have one on the bus.” Maverick cleared his throat. “So…” He drew out the word. “Next steps. We’re thinking transport?” He wasn’t ordering or directing. He worked as a team member, nudging her toward the correct answer.
Heck, yes. Bruce needed to be out of her ED, stat.
Her head bobbed. “He can’t stay in this facility. We don’t have an ICU or ventilator here.” She thought through the unfamiliar resources out loud. “He needs to be in Fairbanks for critical care and cardiology management.”
“Louise, could you call the evening shift EMS crew?” Maverick asked. “We have a transport vent on our rig.” He paused. “Um, did you want a chest x-ray? Sedation during transport?” Throughout his questions, he kept squeezing the green ambu bag, creating steady, even breaths for Bruce.
Damn it. Her knees shook. She needed to focus on post-resuscitation stabilization.
Her thought processes took a while to catch up. “Yes. Absolutely. Portable chest, please.” The radiology tech outside the room acknowledged the request and set up the machine. Lee then turned to Deirdre, who was holding open doors for the tech’s machine. “Do you have Precedex in-house?”
She closed one eye and looked up at the ceiling. “Nope. Go fish. Got a second-choice sedating med?”
Lee’s heart pounded. She checked the ACLS app on her phone. It didn’t hold this answer.
She racked her brain, aware of seconds ticking along with the regular telemetry beeps. “Propofol?” Anything to provide sedation while he was intubated. Once he was evaluated further in Fairbanks, he could then be extubated in a safer setting.
“Bingo!” Deirdre quipped. “Back in a sec.” She hurried to the ED’s Pyxis medication dispenser in the center of the ED.
The radiology tech and Amberlyn slid the film cassette under Bruce’s upper back, with Maverick maintaining the ET tube and airway. The tech squinted at Maverick and the ambu bag, then draped a protective lead apron over his neck and shoulders, covering him to his upper thighs. The whole time, Maverick continued to ventilate Bruce.
Lee and everyone else but the lead-aproned tech and Mav stepped out to avoid radiation exposure while the machine whirred and beeped.
Reentering the room, Lee pulled up the digital image on the portable x-ray machine’s screen. ET tube in proper position. No pneumothorax. Cardiac silhouette was normal. No significant infiltrates in the lungs.
After the portable x-ray machine was trundled away, Deirdre hung the Propofol drip. Sedation was on board.
Lee shifted from foot to foot, every cell in her body wanting Bruce out of this hospital and at the larger Fairbanks facility. Now.
Maverick lifted his chin toward the trauma bay door. “Any day now with that transport vent, Louise. I’m getting carpal tunnel here.”
His partner rolled her eyes and indicated for everyone to move so she could set up the equipment.
Lee gripped the bed railing. Next steps.Think. The on-call CRNA, Thomas, arrived, a perplexed expression crossing his face when he spotted Maverick and Louise and their equipment.
“I missed the party.” He pulled a fur-lined hat with ear flaps off, revealing his close-cropped hair.
“Tom, could you scroll through the telemetry leads for me?” Lee asked.
Because if she knew one truth of medicine, it was that the doctors should never touch the monitors, vent settings, or the IV pumps, else they risked dirty looks or dismemberment by the rest of the healthcare team. Tom turned the dials, cycling through to show the readouts from available leads. It was like reading the EKG without needing to run a formal EKG. A quick way to get big-picture information.
“There.” She pointed. “Tombstone.” Lee used the expression to describe the characteristic EKG appearance in the early phase of an acute heart attack.
Maverick whistled low.
Deirdre winced and patted Bruce’s arm. “Oh, Bruce.” She quietly sniffled and met Maverick’s eyes for a split second.
