Emergency

We we were all settling in for our evening team meeting around 7:30 pm when a General Surgeon from the Hospital, Dr. Cespedes showed up looking for the "Otorino" (that's me). He had a patient about 40 years old who thought he got a fish bone stuck in his throat about 8 hours ago. He wanted me to come and help get it out. "Fish bone", I thought, "no big deal. " I've seen lots of foreign bodies including many fish bones. I'd get to show them how easy foreign bodies are. They are one of my favorite things. Quick, easy cure. So we gathered up a few instruments and my headlight, a fiberoptic scope and scrubs. It turns out Dr. Cespedes came in the Ambulance to get me and was a little anxious. I went along with Dr. Diedrichsen (next to me) as assistant, Tam Boettcher to photograph our first emergency and Dean Athey (at the head) in case we needed to put him to sleep to get it out. Suzie and Keveta (green print hat), the nurses here who know the system well, came along to keep track of us. When we got to the ER there was a man with a neck as swollen as any I've ever seen. A little guy with a NFL linebacker thick neck, in obvious distress. I won't give all the details, but the option was to 1) put him to sleep, do a tracheotomy to secure an airway and then see what was in his throat, or 2) let him die. We decided we would go with #1. Dean gets the big award for putting him to sleep with much finesse and securing the airway with me standing by with a knife in hand and neck scrubbed. Once we had an airway Dr. Cespedes (across with no headlight) and Dr. Diedrichsen (next to me) assisted me (black headlight) in the tracheotomy which went without a hitch. We then had time to look at the massively swollen throat. There was no foreign body, no abcess, no obvious infection and no real explanation for the problem. There is no CT scanner here so we couldn't get one of those. I kept asking if we could get a white blood cell count to check for infection. They didn't seem to know at first, but finally decided they could. I have to confess they never did draw any blood, but they said they would. We couldn't just leave a breathing tube in through his mouth because there is no ventilator and he would have to be kept asleep if he had one, or he would thrash around so much it would come out and lose his airway. We left him in the ICU on antibiotics and steroids with a tracheotomy tube stitched in and no family anywhere. The ICU nurse had to hunt awhile to find some suction and oxygen, but we left him there stable for the night with oxygen and suction. We got home about 11 pm. NN