3:00 AM: ask Mum to let go of her pink and warm 8 month old so we can put the tube thing in and get ready for the peds team to come take her south. Kid has obviously gross sounding chest and snotty nose but wiggles and looks around.
3:30 AM: drugs in, tube in, CO2 detector doesn't change colour, chest doesn't rise, but the tube is audibly for sure without-a-doubt in. Sats are 2. Heart rate is 65. We extubate and bag by mask.
3:45 AM: The best sat we get is in the 60s. We need to get a tube in and vent the kid with higher pressures: as it stands his nasogastric tube is draining all over the bed because of the bag-mask ventilation. I have a hand cramp from bagging at a rate of 70 with high pressures through a mask.
4:00 AM: We call a code. A smaller tube is in: we couldn't get the same size in, I'm going to blame it on laryngeal edema. Pediatrician is literally throwing his hands up in the air. We are shooting in Ventolin every route we can possibly think of. We take another chest x-ray. The lungs are an opaque mass of gelatinous pulmonary edema and pneumonia. This is a complete 180 from an hour ago, the last chest x-ray standing in stark contrast. There was air in there once. Not anymore.
4:30 AM: We let mom back in to hug her pale, waxy, ashen baby girl. I feel like a dick because I have to move her aside to get my Winnebago of a ventilator out of the room so she can be left alone. Pediatrician assures me the kid was a ticking time bomb: according to the Peds ICU South where she was going, they've had this happen a few times in the last few months and they aren't surprised.
I have never seen things turn around that fast in an adult. Not without there being some big arm-waving obvious cause, like a tension pneumothorax. I'm glad I don't work in PICU.