Among high acuity critical care patients seen in our unit, those needing extracorporeal membrane oxygenation (ECMO), arguably, are the most severely ill and require care of the nursing professionals, who received extensive specialized training. Although not all patients survive and regain functional recovery, the life testimony of those, who do, marks a long-lasting imprint in the memory of care providers. So did the story of Mrs. X. who I met last winter. Like many of her counterparts, Mrs. X. developed respiratory distress, failed mechanical ventilation, and was emergently transferred to the PPMC for ECMO management. Due to the body habitus and difficult airway, Mrs. X. underwent a bedside tracheotomy procedure shortly after her admission. …show more content…
The frustration in the room grew palpable as after obtaining and reviewing dozens of images of the patient's oral and nasal cavities a source of bleeding still could not be identified. The physician in charge looked very upset about the whole story. I knew it was my professional duty to speak up and convey my suspicions that the bleeding, in fact, was not originating from the patient's oral cavity, but related to the tracheostomy. Fighting my internal intimidation, I politely asked the doctor, if there was any chance, he could inspect the area around the patient's tracheostomy site. I explained that looking through the patient's records and observing the patterns of bleeding, I suspected, that the bleeding followed the trach insertion. Initially, the doctor was hesitant, and replied that the consult request stated that the patient was bleeding from her oral cavity. Reluctantly, he agreed to discuss the matter with the HVICU attending over the phone. I dialed the attending, and after a short conversation, the HUP doctor proceeded with imaging of the neck. I held my breath in anticipation watching his facial expression as he was carefully inspecting the neck imaging. In fact, that’s where he found the bleeding, which originated from a small branch of the external carotid artery. Minutes later he successfully deployed the coil to the vessel, finally stopping the bleeding. Returning to work after several days off, I learned that Mrs. X regained consciousness, was decannulated, and transferred to the long-term care facility for the weaning from the