PORTLAND, OR – Ms. Wee was prepped for her biannual joint replacement in OR 4, but this time would be different. Anesthesia resident Dr. CJ Van Ross would be at the helm, stationed at the head of the bed for the second time since July.
“I was nervous, but I successfully intubated the 28 week premature fetus mannequin during NRP so I felt ready,” reports Van Ross.
OR nurse Michelle Lawrence had her reservations as well. A 24-year OR veteran, Lawrence sensed that Van Ross was in the early stages of training. “He led the debrief and actually looked at the checklist on the wall and followed it. It took forever, but he’ll learn soon enough!”
Induction went smoothly but Ms. Wee’s intubation proved challenging for the entire OR staff. Lawrence states “She was out and paralyzed, and the anesthesia resident kind of stood there.” The senior resident and attending were on hand, helpfully shouting the patient’s more-or-less stable vital signs. All seemed lost and the team prepared for a quick intervention to prep her for another attempt when Van Ross asked for some cricoid, then the tube, which was placed in one attempt and the cuff inflated. His attention turned to Ms. Wee’s symmetrically rising chest and the reservoir bag. While holding the tube in her mouth, Van Ross verified tube placement with bilaterally equal breath sounds and end tidal CO2 before taping it in place, 21 cm at the lip.
“I’ll admit it, I was impressed,” mused Lawrence. “There was so much chaos in the 20 seconds that the kid needed to get the job done, but by god, he did it.”
Attending Anesthesiologist Todd Davidson, MD agreed. “I was a little concerned about the magnitude of the patient’s lack of decompensation and Van Ross just started. I mean, he didn’t do things the way I would have, but I appreciate how he kept his calm.”
Van Ross’s side is a bit different. “As I raised the epiglottis and asked for pressure, I realized I initially picked up the blade with the wrong hand. I felt so dumb! Then I heard a bunch of unintelligible screaming and beeps before reminding myself to put the tube in the hole between the cords, which I then did. I was so embarrassed!”