I was transporting a patient post-operatively from the OR to the ICU the other day. He had been on the ventilator for 10 days or so after his open heart, CABG, and needed a tracheostomy due to the development of ARDS. After an uneventful operation, I hooked him up to an oxygen tank and started bagging him via the trach (giving him breaths with the assistance of a ambu bag). His vital signs were stable during transport, which lasted about 2- 3 minutes tops. Once in his ICU room, we hooked him up to the room monitors. While we were doing this, he appeared dusky, blue to me, even though the pulsox read mid 90s. Then suddenly sats dropped to 81%, now consistent with his hue. We added some PEEP, and got his sats back up. Because of his ARDS, he had been on some PEEP, and went without it during transport, just enough time to temporarily drop his sats. Everything was fine, but it emphasized to me something that I had been practicing since I started in this field: the importance of looking at your patient rather than looking at just the numbers. He was blue even though the numbers had been fine. My heart starts to race a little faster, my senses become a bit more heightened when I see that dusky blue color -a sign of hypoxemia, a sign that the "A" in ABCs might be compromised, a sign that something is wrong, a sign that something bad might happen pretty quickly.
When I see that color, I am reminded of that dreaded feeling when a patient turns blue. I have since changed the background color on my blog (looks like SR Phoenix's blog!) and opted for a healthier looking color.
