What would you do?

I'll post a case from my last night on call since the forum is dead. RN calls me at 10:00 PM to come see ICU pt for respiratory distress. Get to the bedside 10 min later. Morbidly obese WM (50'ish) with RR low 40's sitting upright in bed. Pulse 115, afib BP 80/40's by radial A -line spO2 89% on NRB Weight 425 lbs massive subq air extending up to head Head shape/size of a pumpkin Can not open eyes due to subq air in eyelids Awake and will follow commands but not talking Can open his mouth about 1.5 inches Quick update by RN: POD #3 from CABG, EF 45 % pre-op Extubated POD #1 Still on dobutamine for lowish CI (has triple lumen catheter, no swan) Chest tube and mediastinal drain removed about 6 hours previously SQ air first noted about an hour ago - has progressed rapidly RN and RT have already gotten abg and cxr: ABG 7.27/65/60 CXR - tons of overlying soft tissue, bilateral pneumos -> right maybe 30%, left maybe 20% Review intubation note by anesthesia from OR: Performed by old school anesthesiologist - has been doing cardiac cases for 20+ years "Grade 4 view with miller 2 - 1st pass with bougie" This guy almost never goes with a glidescope for his 1st attempt Available to me at this time of night: -1 anesthesiologist with 2 crna's -probably a couple of ER and IM hospitalists in house -CT surgeon at home kicked back with a glass of scotch I do 90% of my own airways but I'm not afraid to ask for help when things look ugly. Call anesthesiologist -he's brin...
Source: Student Doctor Network Forums - Category: Universities & Medical Training Authors: Tags: Critical Care Source Type: forums