Page 16 of Dr. Alaska
The HUC glanced up with a wink as she typed. Probably taking notes on Mav’s inability to have a normal human conversation and documenting the smoking ashes of his pride.
Shift would be over soon. Mav couldn’t wait to sit by the fire with his old sled dogs. At leastthoserelationships were simple.
Chapter Seven
“Code Blue, EDroom two,” blared overhead on repeat as Lee speed-walked from the inpatient wing toward the ED, joining several staff heading in the same direction. What the heck? Bruce had been stable and getting ready to be admitted for observation at the upcoming seven p.m. shift change. His lab results were reassuring.
Maybe someone had hit the code button by mistake or accidentally pulled the alert cord in the ED restroom? Wouldn’t be the first time that had happened.
Or had another patient recently arrived and coded? Could be. Lee hadn’t looked at the census in the past fifteen minutes. If EMS was coming in hot or if it was a John Doe, the patient might not have been added to the patient list. She fingered her cell phone, ready to pull up the ACLS algorithm. In a critical situation, even the best-drilled protocols flew out the window. Good to have her peripheral brain backup.
She tallied her resources as she hurried down the hallway. Six forty p.m. on a Friday. Drs. Burmeister and Moore as well as one of the physician assistants were all off today. The remaining PA had finished up their clinic schedule a few hours ago. The nurse anesthetist or CRNA took hospital call from home. Lee peeked out of a window. Windblown snow swirled beneath parking lot lights. The CRNA wouldn’t arrive quickly enough.
Swiping her badge to enter the ED, Lee paused. A radiology tech rumbled the portable x-ray machine to a stop outside of room two. In the hallway, a rolling phlebotomy cart with a lab tech standing ready next to it waited in the hallway. The ED HUC stood at the trauma bay door with a laptop computer on a stand, acting as scribe, and moved so Lee could enter the room.
Lee stumbled on her own footstep.
It was Bruce.
Lee pulled in a lungful of air. Time slowed down.
Monitors beeped all over the place, ringing out three quick high beeps and two lower, loud beeps, over and over. Insistent sounds of impending death. Not good. Tense, low voices filled the room.
ABC. Airway, breathing, circulation.She could do this. She could run this code.
One of the ED nurses, Clyde, did a limbo move to duck under oxygen tubing on the wall and step over cords to start bag-mask ventilation from the head of the bed. He pressed Bruce’s jaw up against the mask to create a tight airway seal despite Bruce’s beard hair. Bruce’s chest rose with each squeeze of the green ambu bag.
An ED nurse, Amberlyn, stood on a footstool, performing CPR compressions. The day shift charge nurse for the inpatient unit ran in wearing the Lucas compression device backpack. She set it on the counter and began unpacking it.
Lee took another big breath and positioned herself at the foot of the bed, gripping the footboard for support. An attending physician would be helpful right about now. She quickly scanned the team around her. No luck. Not a cardiologist, ER doctor, or critical care specialist in sight, either. Damn it. Shewasthe attending physician.
The sight of Bruce’s pale face and lax body shot adrenaline through her, driving her to panic. Driving her to rush through the steps.
No.The words of Dr. Tyanna Ross, one of her OB fellowship attendings, floated up from several years ago when Lee was elbow-deep in emergency C-sections and high-risk deliveries.Slow is steady. Steady is smooth. Smooth is fast.
“Update.” Lee projected her voice to stay calm but carry over the incessant and loud telemetry alarms.
Deirdre glanced up from where she knelt, placing a second IV line and drawing several tubes of blood. Keeping her eyes on her work, she said, “Chest pain started a few minutes ago along with increasing O2 requirement. Initial troponin level was normal. We were waiting on the four-hour repeat troponin before admitting him. Amberlyn”—she nodded toward the nurse doing vigorous compressions, her long, dark hair floating in front of her face—“was about to call you, but then Bruce said he felt ‘something wrong in my chest.’ He lost consciousness. Telemetry went from sinus to sinus tach, and about thirty seconds ago, it rolled straight over to V-fib.” A quaver roughened her words.
She handed off the multiple vials to the lab tech, who hurried out of the room. Then she taped the IV in place with a deft flick of her wrist and stood.
Lee stared at the monitor that displayed small irregular waves. It beeped with alerts but emitted no sounds of regular heartbeats. Ventricular fibrillation—an unstable heart rhythm incompatible with survival. “Pulse?”
Clyde pressed on Bruce’s neck. “Not palpable.”
“Let’s shock.”
“Got it.” Deirdre retrieved pads from the top drawer of the rolling CPR cart and slapped them on Bruce’s hairy chest as Amberlyn restarted compressions.
“V-fib. Shockable rhythm,” Lee confirmed once more, sweat prickling between her breasts. The likely cause of Bruce’s collapse was cardiac, but she had to think through all reasons for the arrest. Pulmonary embolism, sepsis, cardiac tamponade, pneumothorax, electrolyte disturbances.
“Charge to one hundred twenty joules.” Lee stepped away from the bed. “I’m clear.” She scanned the room as Deirdre moved away from the metal railing.
Clyde lifted the ambu bag away from Bruce.
“You’re clear.” Lee checked once more as Amberlyn raised her hands and stepped back. “Everyone’s clear. Shock.”
Deirdre pushed the button, and Bruce’s body jumped.
