General

How to Respond to a Code Like This?

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8 Jul 2016 - General
 

 

I was on a 12-hour shift yesterday and while I was busy carrying out doctors order, there I can hear the woman on the pager, "Dr. Po To MAMA Ward!", here we go again for another code! Doctors keep on running to rescue going ahead to the unit!

The scenario was, there was an elderly who accidentally swallowed his dentures. It can't be visibly seen upon opening the throat, the patient desaturated, elevated blood pressure, no IV lines. So a heimlich maneuver was performed by several people including men and it couldn't really be removed. Time's starting to tick-tock like a time bomb. This is somewhat a weird pitiful kind of situation. Seriously, from all the foreign objects, this?

If you were in the situation, what interventions are you going to take? What steps should the healthcare professionals have taken before the incident had happened?

Before it happened? I think it should've been known to that the patient is wearing dentures and that it is ill-fitting (loose). If so, maybe he could've been told not to wear it anymore; otherwise, they should have made sure that it is fitted with denture adhesive so that it does not dislodge easily. A lot of patients, with extremely resorbed alveolar bones, still insist on wearing their dentures. Not really for the “masticatory” function—they cling on to it for the aesthetics, so even i...
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That is why I can never survive in A & E. The mortality rate will shoot right up. Who knows my laryngoscope blade may dislodge and drop into the larynx as well. While trying the needle cricothyriodotomy I may accidentally picked up a chest tube and pierce all the way into the spinal cord draining CSF. Too many possibility. Or I may simply see the denture in the larynx and used the blade of the laryngoscope to push it in further trying to aim for the oesophagus instead. A laryngoscope is ind...
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If the patient is choking and his vitals are crashing down, a needle cricothyroidotomy would have been the ideal thing to do in that kind of situation. I agree with Esther. If you are sure that a patient is choking on something but you can't properly visualize a foreign body in the throat, introducing a laryngoscope could possibly make things worse by pushing it far down the larynx. Laryngoscopic examination is difficult even in a patient who is sedated, so inserting a laryngoscope into a ch...
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Thanks to you. Now I am ready when I see an elderly without dentures in his mouth choking. At least I am prepared what to do. So far I have removed objects from the ears, eyes, nose, anus, oral pharynx and female genitalia but yet to remove any from the hypopharynx. I hope it will never happen in front of me. Did he put his denture back on again? Hopefully he did not. I am not surprise the Heimlich did not work given the fact that the air generated probably will not face much resistance from a d...
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How did you know he accidentally swallowed his denture? I guess if I am around and he is showing the universal sign of choking, I will perform a heimlich maneuver. If the object was not expelled and the patient is turning cyanotic, I may get a layrngoscope and have a look into the hypopharynx. I am sure it must be possible to visualise the denture with a larngoscope. If it can be visualsied, it probably can be removed with a Mcgill forcep. If all else fail, I will seriously consider an emergency...
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