Called for a patient unresponsive and breathing.
We arrive to find a male patient unresponsive, breathing and stable vital signs. The nursing home staff (all 6 of them in the room) tell me the patient’s SpO2 was in the 80’s but it got better with oxygen, applied via a nasal cannula 2 lpm. That’s all well and good, but the patient has a shiley trach. I additionally noticed a suction canister with 1000ml of pink fluid. I asked if that was all from today, one nurse said she left it there so I could see how much was suctioned from the patient over the last few hours.
First, I put my gloved finger over the patients trach, and magically watch the SpO2 rise. The nurse then says she cannot find the obturator. I give a listen to the lung sounds and hear, rales of course. Time to head towards the hospital. In the back of the ambulance I ask my partner to bag the patient via the trach, since CPAP is not available to me. I start an IV and consider my treatment options. We are only 1.5 miles from the hospital, I choose to just bag the patient for the short trip. I now noticed that the cuff on the trach is completely flat (which explains why I am not getting good respirations while bagging). I inflate the cuff and transport to the hospital.
Take note nursing students, placing a trached patient on a nasal cannula with out the obturator is a useless as….. well you get the point.