Life Support Read Online Free PDF Page B

and the answer instantly became apparent to her. The woman's obesity had obscured the fact that her jugular veins were bulging.
    "You said she had an MI six weeks ago?" Toby asked.
    "Yeah," the driver grunted out as he resumed chest compressions.
    "That's what the husband said."
    "Any other meds besides Digoxin?"
    "There was a big bottle of aspirin on the nightstand. I think she's arthritic."
    That's it, thought Toby. "Maudeen, get me a fifty cc syringe and a cardiac needle."
    "Gotcha."
    "And toss me some gloves and a Betadine wipe!"
    The packet flew toward her. Toby caught it in midair and ripped it open. "Stop compressions," she ordered.
    The driver stepped back.
    Toby gave the skin a quick swab of Betadine, then she pulled on the gloves and reached for the 5Sec syringe. She glanced one last time at the monitor. The rhythm was still a rapid sinus. She took a deep breath.
    "Okay. Let's see if this helps . . ." Using the bony protrusion of the xiphoid process as her landmark, she pierced the skin and angled the needle tip straight toward the heart. She could feel her own pulse hammering as she slowly advanced the needle. At the same time she was pulling back on the plunger, exerting gentle negative pressure.
    A flash of blood shot into the syringe.
    She stopped right where she was. Her hands were absolutely steady. God, let the needle be in the right place. She pulled back on the plunger, gradually suctioning blood into the syringe. Twenty cc's.
    Thirty. Thirty-five . . .
    "Blood pressure?" she called out, and heard the rapid whi.f>, whi�of the cuff being inflated.
    "Yes! I'm getting one!" said Val. "Eighty over fifty!"
    "I guess we know what we've got now," said Toby. "We need a surgeon.
    Maudeen, get Dr. Carey on the line. Tell him we've got a pericardial tamponade."
    "From the MI?" asked the ambulance driver.
    "Plus she's on high-dose aspirin, so she's prone to bleeding. She probably ruptured a hole in her myocardium." Surrounded by blood in the closed sac of the pericardium, the heart would be unable to expand.
    Unable to pump.
    The syringe was full. Toby withdrew the needle.
    "Pressure's up to ninety-five," said Val.
    Maudeen hung up the wall phone. "Dr. Carey's coming in now. So's his team. He says to keep her stabilized."
    "Easier said than done," muttered Toby, her fingers probing for a pulse. She could feel one, but it remained thready. "She's probably reaccumulating. I'll need another syringe and needle pretty quick. Can we get her typed and crossed? And let's get a STAT CBC and Iytes while we're at it."
    Maudeen pulled out a fistful of blood tubes. "Eight units?"
    "At least. Whole blood if we can get it. And send down some fresh frozen plasma."
    "Pressure's falling to eighty-five," said Val.
    "Shit. We'll need to do it again."
    Toby ripped open a packet with a fresh syringe and tossed the wrapping aside. Already the floor was piling up with the debris of paper and plastic that accumulated during every code. How many times will I have to repeat this? she wondered as she positioned the needle.
    Getyour butt over here, Carey. I can t save this woman on my own . . .
    Toby wasn't sure Dr. Carey could save the patient either. If the woman had blown a hole in her ventricular wall, then she needed more than just a thoracic surgeon�she needed a full cardiac bypass team. Springer Hospital was a small suburban facility, perfectly capable of dealing with cesareans or simple gallbladder resections, but it was unequipped to deal with major surgery. Ambulance teams transporting serious trauma victims would normally bypass Springer Hospital and head straight for one of the larger medical centers like Brigham or Mass General.
    This morning, though, the ambulance had unknowingly delivered a surgical crisis right to Toby's doorstep. And she didn't have the training�or the staff�to save this woman's life.
    The second syringe was already filled with blood. Another fifty cc's of it�and it didn't clot.
    "Pressure's going down