Meats and veggies are certainly part of a well balanced diet.  You just have to make sure to get them to the right place.

With that in mind, EMS pulled up to our back door.  This was not our local podunk EMS, but rather one of our really podunk services from an outlying rural community, whose performance tends to be, um, uneven.

They knew this lady well, as she was a known IV drug user, and they had been called out to her place a bunch of times in the past.  Did we mention she’s an IV drug user?  Apparently she was eating dinner with her dad and started choking.  He tried the heimlich but she didn’t get any better, so he called 911.  Oh and also, in finishing up their presentation, she’s an IV drug user.

Yeah, ok I get it.  You said she was choking?  She looked terrible – she couldn’t talk and was leaning forward with labored stridulous respirations.  We hooked her up to the monitor and got a low-pitched boop-boop-boop back — a good waveform and oxygen sats of 25%.  As the nurses scrambled to get some supplemental oxygen going, I got a good look inside her mouth, but didn’t see anything out of the ordinary.  We put her on a non-rebreather and her sats fortunately came up to around 95% or so, buying us some time to try to start an IV.

Which was a real challenge, since her veins had taken a beating from all the aforementioned IV drugs.  But finally one of the nurses, much to her credit, was able to establish one.

We used it to give her some meds to knock her out.  I used my fingers to pop her mouth open and slid the laryngoscope to the back of her throat.  I found her epiglottis, but just underneath where you would normally see the vocal cords I saw instead a big glistening gob of whitish goo.  Had I been smarter I would have had some forceps at the bedside, but fortunately while nursing was digging some up for me I was able to get behind it with the yankauer suction catheter and slowly guided it out of her mouth.  I went ahead and intubated her and then got a better look at what she had choked on, a nasty conglomeration of steak, broccoli, fat, and oral secretions. 

As always, I shrugged it off as no big deal, but in actuality this was flat out exciting.  In fact, it’s possible that I may have taken a moment to walk to the doctor’s lounge, where now with no one looking I may or may not have thrown a fist pump or two.