Brace yourselves for a perfect storm readers...
Chapter 16
"Code red, CCU, Code red CCU" the sound of the speaker system startled Sara where she was sitting with her head on her mom's shoulder. She jumped up and sprinted to Tegan's room, Sonia followed closely. She stopped at the nurses' station and banged repeatedly on counter. "What does Code red mean... what does it mean?" she screamed. "Sara, calm down" said Arizona holding onto Sara's shoulders. "It means that there's an emergency situation but she's still with us... calm down" Sara pulled herself forcefully out of Arizona's grip and briskly walked into Tegan's room. Kate was there shouting orders. Erin, Lindsey and Sonia was standing next to the wall, they were all in tears. Erin was holding Lindsey who looked as if she could collapse any second. "Pulse ox is falling fast, only 60." said Karev. "Dammit, BP's falling off a cliff... 50 over 30" said Kate sounding panicked. Let's do an echo, I suspect pericardial effusion and a cardiac tamponade. Kate ordered more drugs as Karev switched on the echocardiogram screen. "Lots of fluid around both the heart and lungs." She turned to one of the interns "book the emergency OR now – we need to remove that fluid and get her on ecmo" Alarms were screaming everywhere. Tegan's pulse became slower by the minute. "She's bradying down... pulse only 40, BP down to 40 over 20" said Karev alarmed. "OR can take you in 10" reported the intern. "We don't have 10 minutes! We need chest tubes in both sides please. I'll do left, Teddy – right please"
Kate felt her hand shaking as she took the scalpel from the nurse. She was breathing fast. The mask on her face felt as if it was smothering her. She ran her fingers over Tegan's ribs. She felt the scalpel break Tegan's skin and cut into her muscle, through the chest wall and into the pleural space. Kate forced two fingers into the hole and put a chest tube in. "I'm in, Karev suture this please" she said calmly. Teddy did the same on the other side. Bloody, watery fluid immediately drained from the tubes. "More suction please" she asked urgently. "Pulse ox going up..." she said looking at the monitor and listening to Tegan's lungs with her stethoscope. "Pulse is back up to 60, Ox is 70, BP up slightly to 50 over 30" reported Karev. "She's far from solid ground, let's get her to the ER, prep for pericardiocentesis and ecmo insersion and hope her BP holds" As they started pushing the bed towards the door another alarm sounded "BPs crashing fast, 30 over 10... Pulse down to 30. BP 20 over 5... lost her pressure" screamed Karev looking at the blinking 00/00 on the screen. Kate screamed more drug orders. "Is she bleeding from the chest tubes? Check please. Come on Tegan, stay with me" said Kate as she pulled down her mask and took a big gulp of air. The heart monitor alarmed changed tone. "Loss of pulse, she's in PEA" said Teddy. The dreaded automated voice came over the speaker again "Code blue CCU, Code blue CCU"
Kate immediately started chest compressions on Tegan. "I need one of Epi stat, push through the central line" she said urgently. Karev pumped oxygen into Tegan's lungs with a bag connected to the ET tube. Let's get her on a back board. They rolled Tegan onto the backboard, careful not to dislodge the chest tube. Kate ordered some blood tests. "Put a rush on those labs please" she shouted to the nurse as she left the room. "Still PEA said Kate after a quick rhytm check. PEA showed electrical activity, but the heart either does not contract or there are other reasons why this results in an insufficient cardiac output to generate a pulse and supply blood to the organs. Tegan's arm was hanging partially off the bed. It jerked up and down rhythmically as Kate continued compressions. Everyone was quiet, the only sounds now were the monitor alarms, the very faint "huh huh huh huh" sound caused by the pumping on the sternum that escaped Tegan's ET tube and the sound of quiet sobbing coming from the corner where Tegan's sister, lover, mother and best friend was standing.
Sara walked forward, her hands in her hair. "Shock her! Why aren't you shocking her!" she screamed. Nurse Abbey put her hand on Sara's forearm "Tegan's heart is not in a shockable rhythm Sara. We can't shock it now" she said calmly. "Somebody get them out of here please" said Kate still pumping profusely on Tegan's chest. "Guys you're going to have to wait outside, we'll update you as soon as we can. Come on" she tried herding them outside. "I'm NOT leaving her" said Lindsey with tears rolling down her cheeks, refusing to move. "I'm NOT, I'm staying!" nobody else moved either. Abbey gave up trying. The nurse ran in with the lab results and conveyed them to Kate. "Rhythm check in 5, 4, 3, 2, 1" said the code recorder. Kate's hand flew to Tegan's neck as she desperately looked at the monitor. "No pulse, still in PEA. Let's push 60 Meq of sodium bicarb. Open the saline wide and let's up the dopamine and start a lidocaine drip?" she said as she started pumping again. She continued pumping for about 20 seconds and stopped briefly "Okay, she's shockable, v-fib let's prepare to shock at 200" said Kate calmly as they ripped off Tegan's gown and placed the orange conductor pads on her chest. "ok we're charged – everybody off – stay clear – shocking" Tegan's body jumped as the defibrillator made it's thump sound.
Everybody stared desperately at the monitor screen. It continued its squiggly line. "No change let's go with 300..." Teddy had taken over compressions as Kate waited with the paddles in her hands for the defibrilator to recharge. "Charged – stay clear – shocking" said Kate and pressed the red buttons on the paddles. She felt the charge go through the machine and into Tegan's body. She felt Tegan's small body lift under her hands from the shock. "Still no change, let's shock at 360 please... Come on Tegan, come back to us" said Kate as she waited for the machine to charge "Charged – stay clear – shocking... No conversion"
"Tegan come on, Tegan don't do this" shouted Sara, tears gushing from her eyes. She was frantic. Lindsey was staring at Tegan in an almost catatonic state. Erin didn't want to leave Lindsey but she didin't want to see any more of this. She put her arms around Lindsey and held her shaking body facing the other way. "Tegan please! Please Tegan please ... please" Sara was wailing.