Securing the Airway, Part 3
I sat on the sofa in my officetel, repeatedly slicing open and suturing an imaginary neck in the air dozens of times. I was slowly starting to find this lesson interesting.
A new anatomical image was uploaded. The epiglottis. The tiny lid that opens and closes the airway. Normally, it should be thin and pink, but this epiglottis was swollen a bright, angry red. The bloated epiglottis looked ready to burst at any second, almost completely blocking the already narrow airway.
Damn it. This is a trap.
If you carelessly shove a laryngoscope in there, you risk irritating that highly sensitive, swollen epiglottis and triggering a complete airway obstruction. Cold sweat dripping down my neck, I desperately typed out my answer.
I wracked my brain. First and foremost, irritation had to be minimized.
Right on cue, Pediatrics Ghost 77 materialized in the thread like a phantom.
I engraved their advice into my brain. No sooner had that lecture ended than the next image was uploaded.
The throat of a post-tonsillectomy patient appeared before my eyes. A blood vessel at the surgical site had ruptured, and crimson blood was geysering from deep within the throat.
Ah, wait, what was it again? Shouldn't we suction the blood out first?
Securing the airway, and protecting the airway. Right. Note to self.
And so, sitting on the sofa of my officetel, I repeatedly killed and saved imaginary patients in the air dozens of times.
The alarm rang. Same time, same sound. The signal that it was time to return to hell.
Dragging my body, which was already tattered from the intense study session, I mechanically got ready for work. But what else could I do?
The morning in the ER passed quicker than expected. There wasn't much work, and since the vast majority of patients had minor complaints, it wasn't too burdensome.
The afternoon in the ER, however, was a chaotic marketplace as always. I was tucked away in a corner of the station, charting a simple laceration patient who had just come in—an older man who had stumbled while drunk and planted his head into the asphalt.
"Aigoo, mister. You should've watched your drinking."
I muttered to myself as I continued charting. It was just another boring, exhausting day in the ER. After dealing with about ten of these patients a day, my soul felt as frayed as a piece of gauze soaked in antiseptic.
It was right then.
"Dr. Han!"
The voice of the head triage nurse rang out across the floor.
"Could you come over here for a second? We have a patient who just arrived, and I think you need to see him right away."
Those words from a veteran nurse never failed to send a shiver down my spine. Shudder.
I saved my progress on the chart and stood up.
When I reached the triage desk, a young man in his early twenties was sitting in a chair, looking absolutely terrified. I approached him and pulled up a stool.
"Yes, hello. What brings you in today?"
At my question, the man looked at me with anxious eyes and replied, "Um... I had a tonsillectomy last week. But I keep smelling blood, and it feels like there's something in my throat..."
Ah, wait. A tonsillectomy? Smelling blood?
"You had a tonsillectomy a week ago, and you're smelling blood and feeling a foreign sensation in your throat? Could you tell me a bit more about that?"
"It doesn't really hurt or anything... but I keep smelling blood from the back of my throat... and every time I swallow, it feels like something is pooling and rising up. It's really unsettling..."
I tried to reassure the patient first as I reached for my penlight.
"Alright, could you open your mouth wide for me? Let me take a look inside your throat."
The man opened his mouth. I shone the penlight deep into his throat, examining the site where his tonsils had been removed. At first, nothing seemed out of the ordinary. But the moment I gently depressed his tongue with a tongue depressor to get a clearer view—
I saw it.
A tiny, bright red bead of blood was oozing from a microscopic gap in the surgical scab. It was slow, but it was undeniably active bleeding.
My mind went completely blank. Right now, it was just a slow trickle, but this was a ticking time bomb. If his blood pressure spiked or if he coughed the wrong way, the blood vessel could completely rupture.
I'm screwed.
Masking my panic with a calm expression, I asked the patient, desperately hoping my voice wouldn't tremble.
"Did you have the surgery done at our hospital?"
"Yes. A week ago, by Professor Kim Jae-young in ENT..."
The moment the patient answered, the hellish training session with the ghosts flashed through my mind like a panorama.
—Alright, next is a patient with blood gushing from their throat!
—This is about securing the airway. Securing the airway is the absolute priority, you idiot!
—You sweep the tongue and blood clots out of the way all at once with the largest laryngoscope blade, shove the tube in as fast as possible to secure the airway, and inflate the cuff to prevent blood from aspirating into the lungs!
...Holy crap, is this why the ghosts made me practice airway management? Are these guys shamans or what? Ah, right, they're ghosts. Is this some kind of ghostly premonition?
"Sir, listen to me carefully. There is some bleeding at your surgical site. It doesn't mean it's definitely going to become a major issue, but just in case—to prepare for the absolute worst-case scenario—we're going to start a few procedures."
I turned away from the patient and began shouting to the nurse standing behind me.
"Get this patient a bed in Zone A immediately! Start monitoring right away! We have a post-op bleeding case!"
At my urgent shout, the peaceful atmosphere of the ER instantly froze.
"And establish two large-bore IV lines on both arms right now! Run a STAT CBC and coagulation profile, and prepare a crossmatch for four packs of packed red blood cells!"
My mouth didn't stop for a single second.
"Call the ENT resident on duty immediately! Tell them we have active post-tonsillectomy bleeding! They need to come down right away!"
I took a sharp breath and delivered my final orders.
"And... bring the largest laryngoscope blade, a size 7.5 endotracheal tube, and a suction machine to the bedside. Do it right now."
The nurses began moving in perfect, synchronized order. One prepped the IV line while another affixed the patient's label to the blood collection tubes.
Fortunately, the bleeding wasn't severe yet. For now. But this type of hemorrhage could turn catastrophic at any moment. Until ENT and Anesthesiology arrived, I had only one job: keep the patient as stable as possible.
"Nurse, please bring me Bosmin ampoules, a long Kelly forceps, and packing gauze."
A moment later, the requested items arrived on a stainless steel tray. I carefully soaked the gauze in the Bosmin solution, then gripped it firmly with the tip of the long forceps.
"Sir, I'm going to apply pressure to the bleeding site to stop it. It might be a bit uncomfortable. Please open your mouth wide."
Explaining the procedure to the patient, I carefully slid the forceps deep into his throat. Found it. I located the tonsillectomy site. I began to apply firm, steady pressure to the bleeding area with the long forceps.
The patient grimaced. I soothed him while maintaining a constant pressure with my hand.
Right then, an indifferent voice drifted from behind me.
"What is it?"
I didn't even need to turn around to know who it was. Han Jae-eon, the 3rd-Year Resident in Emergency Medicine. Before I knew it, she had approached my side, looking down at the scene with her hands shoved into her pockets.
Keeping my grip on the forceps, I tilted my head slightly to brief her.
"Twenty-two-year-old male, post-tonsillectomy performed at our main branch's ENT department a week ago. Presenting with post-op bleeding, currently packing with Bosmin gauze. Active bleeding is minimal, mostly oozing. Vitals are stable for now, and I've already notified ENT and Anesthesiology."
Listening to my briefing, Han Jae-eon leaned down to peer into the patient's throat.
"Hmm. It's just oozing. Not arterial. Keep applying pressure like that until ENT gets here."
With that, she walked back toward the station. What, you're not going to help me? But just as the thought crossed my mind, Jae-eon grabbed a few supplies and started heading back. Ah, she wasn't running away.
I focused back on the patient. I could feel his pulse vibrating through the forceps. Fortunately, I didn't feel any more blood seeping past the compressed area. The pressure hemostasis seemed to be working.
*Whew, thank goodness the bleeding isn't severe. They'll probably just cauterize the wound and be done with it.* A sigh of relief escaped my lips.
Thankfully, it looks like I won't have to use that hellish airway management technique the ghosts taught me today. Reality isn't always that dramatic, after all. Not every patient spirals into the worst-case scenario.
Staring at the patient's stable vital signs on the monitor, I waited for this tedious compression session to finally end.