The Final Push

“What do we do first?” Porter asked.

Higgins felt the heat rise. He had memorized the algorithm for treating trauma patients, but tonight he was in a position normally reserved for interns or junior residents. This was a rare opportunity, and he had to nail it. “First, connect the patient to the necessary monitors—EKG, blood pressure, pulse oximeter—and then establish intravenous access, fourteen or sixteen gauge IVs in each arm, and start IV fluids at the appropriate rate.”

“Right,” said Porter, “but there are four nurses doing those things for us. What should we do first?”

“Oh, yeah. The ABCs.”

“Which are?”

“Airway, breathing, circulation.”

“So do it.”

“His chest is rising and falling, which indicates his airway is open.” Higgins put his stethoscope in his ears and slid the diaphragm under the man’s bloody T-shirt. He listened to the left side of the chest, and then the right. “He has bilateral breath sounds, but they’re shallow. He’s moving air, but not enough. He needs to be intubated.”

“Yes. You can tell by looking at him that his respirations are agonal, and check out the pulse oximeter. His O-2 sat is dropping. We need to get a tube in him before he codes.”