It was a busy afternoon and the EMT had rushed in a elderly female with conscious disturbance and collapsed during the transit.
She was intubated with a LMA and no Lucas automated CPR machine was used since setting up the Lucas was not practical in the ambulance. The EMT did manual CPR during the transportation. After accepting the case, I did the routine with my team; changing the LMA to endotracheal tube and bla bla bla… The patient was a small frame skinny elderly female and she was febrile.
I proceeded to the family and did a brief history taking. She was fine until noon according to her daughter. She was staying alone and her daughter would bring her meals during noon and evening. When I reentered the resus room, I was stunned by the blood noted from the endotracheal tube. It was fresh blood noted from the ETT. Fever plus bleeding led me to think about the scene of some medical disaster movie; it was hemorrhagic fever until proven otherwise.
I started to chase most of the staff from the resus area. There were only 2 staff left in the room. Patient airway was secured in a closed system while being intubated and ventilated. However we would need to perform suction to clear the tube and everyone exposed would be quarantined should the worst case scenario happened
I called up my infection controller asking her if any recommendation or advice that she could offer; and she told me that I do whatever I think is suitable and asked for lab tests that are relevant.
I was pretty sure that her contact and exposure history was negative and the only hemorrhagic fever around our area that was possible was Dengue. I ordered a Dengue rapid test and proceeded with the resus until the usual 30mins limit. The fever and acidosis had hinted a septic state but yet the focus was unknown.
All our efforts were wasted, I called the time and told the family about my decision and asked them to wait for the lab result before I released the patient.
Everything was negative; there was no coagulopathy nor thrombocytopenia. I released the patient and told the family that a PCR would be done for the serum to final confirmation of the Dengue status.
The cause of blood in the ETT? Well, the culprit was most probably the LUCAS. The automated CPR machine provides consistent and good quality of CPR. God knows how many ribs had been broken by it. The patient was skinny; my final guess was an idiopathy injury due to the CPR machine and most probably she had pneumonia.
During the resus, I couldn't bare to think about having the whole team being quarantined. We are currently shortage of medical and nursing staff and it would be impossible to run the unit if such incident happens.
It was a good lesson for us that loosening of rules does not mean lowering our standard of precaution. Next time I would wear proper PPE before entering an resus scene….
