A = Airway
B = Breathing
C = Circulation
The ABCs of CPR are embedded deep within the memories of every health professional. In five months of providing sedation in the endo room, I had never had to actively manage a patient's airway. If an airway was questionable, a simple repositioning of the patient's head would do the trick.
That all changed today. My patient had been snowed by our most heavy-handed doc. Her respiratory rate was fine, but her SaO2 (oxygen saturation) kept dipping, and she was doing this snoring that made me think she was partially obstructing. Plenty of chest movement with each breath, audible breaths, but I just had the feeling she wasn't moving a whole lot of air. A chin lift didn't help much. I turned the O2 up to 3 liters, then 4. Still she was hovering around 88-91% -- certainly no emergency, but I was not comfortable with her being so low. I did a jaw thrust: 92.....93......95......96. I let go: 95.....94.....91.....89.....86. I ended up keeping my hands on her jaw for most of the procedure. It worked great! Luckily, her other vital signs were stable despite the huge amounts of Demerol and Versed in her system. She needed some Narcan and a trip to the PACU because she wouldn't wake up when we were through. I have the feeling that we crossed the line past moderate sedation into deep sedation this time. I wish certain doctors would go to the sedation workshop that I just attended!