After reading all the wonderful posts on this site, I thought I'd post one of many sphincter tightening cases I've had in my 180 bed, independant practice hospital I work at.

Saturday, 8am, sound asleep...pager goes off...ER. I call them back. The secretary lets me know there is a difficult intubation in the ER and they are requesting anesthesia. Little did I know difficult intubation was the understatement of the day.
As I arrive, I round the corner to see a HUGE man, stomach so big, that I cannot view his head. Cardiopulmonary at the head, BVM, and every agonal breath he takes, they squeeze the bag with all their might (No wonder his stomach is huge!) No IV, heart rate 40. No neck, huge head....after the case, find out he's 430#
HERE I COME TO SAVE THE DAY!!!!

So, standard procedure here. I take a good look. Miller 2 blade, GRADE III view (epiglottis), reposition, another look...same view. Well...lets try mac...what the heck. Mac 4, look, nothing...alright...send me the glidescope!
I slide the scope in, lift...Grade II view with his breath....attempt to pass the tube, not able. O2 sat, 75 and dropping. Heart rate 34. This is getting ugly fast...Trach?? yeah right! chin is resting on his chest his head is so big..and no neck..not to mention the mountain of tissue underneath.
About now, I no longer feel like Mighty Mouse, instead, I'm Foghorn Leghorn!
Rolling throught the advanced airway apparatus rolladex in my head, Fastrach LMA pops up....Why not? I ask for a 5...and immediately one is given to me ( Thank god I asked for those to be stocked in the ER carts a couple mos prior.) The LMA is placed without problem, attempt ventilation...very little air moves in...but he does ventilate a bit. Placement of the ETT goes without a hitch, balloon inflated and PRESTO....airway established. HR still at 32..and he looks as blue as the old scrubs I used to wear as an ER nurse. Atropine 1mg via ETT...and heart rate climbs to 80's. O2 sat improves to 100%. I get a big arm around my shoulders from the ER MD.
Ahhh....what fun we have on a daily basis.
:nurse: :laufband: