Patty spewed up green bile which Jeffrey quickly suctioned away. He glanced at the oximeter readout. That was still holding. Then the fetal monitor alarm began to go off, the baby’s heart was slowing. Before anyone could react, Patty suffered a grand mal seizure. Her limbs flailed madly in all directions, then her back arched in awkward hyperextension.
“What the hell is going on?” Simarian shouted as he came flying through the door.
“The Marcaine,” Jeffrey shouted. “She’s having some sort of overwhelming reaction.” Jeffrey didn’t have time to elaborate as he drew up 75 mg of succinylcholine.
“Jesus Christf” Simarian yelled, coming around the table to help hold Patty down.
Jeffrey injected the succiny1choline as well as an additional dose of diazepam. He was thankful that his compulsiveness had made him change the
IV to a more secure one. The audio portion of the oximeter readout began to fall in pitch as Patty’s oxygenation decreased. Jeffrey again cleared her airway and tried to bag her with the 100% oxygen.
Patty’s seizure movements slowed as succinylcholine-induced paralysis took effect. Jeffrey slipped in an endotracheal tube, checked its position, and ventilated her well with the oxygen. The sound of the oximeter immediately returned to its higher pitch. But the fetal monitor was still sending out its alarm. The baby’s heart had slowed and was not speeding back up.
“We gotta get the baby!” Simarian yelled. He grabbed sterile gloves from one of the side tables and yanked them on.
Jeffrey was still watching the blood pressure, which had started to fall again. He gave Patty another dose of ephedrine. The blood pressure started back up. He glanced at the EKG; it had not improved with the propranolol.
Then to Jeffrey’s horror, just as he was watching, the EKG disintegrated into senseless fibrillation. Patty’s heart had stopped beating.
“She’s arresting!” Jeffrey shouted. The blood pressure fell to zero. Both the EKG and the oximeter alarms began shrieking stridently.
“My God!” Simarian yelled. He had been.hastily draping the patient. He moved up to the table and started external cardiac massage by compressing
Patty’s chest. Sheila put out the word to the OR desk. Help was on its way.
The crash cart arrived along with additional OR nurses. With lightning speed, they prepared the defibrillator. A nurse anesthetist also arrived.
She went directly to Jeffrey’s side.
The oxygen content of Patty’s blood went up slightly. “Countershock her!”
Jeffrey ordered.
Simarian took the defibrillator paddles from one of the nurses. He applied them to Patty’s bare chest. Everyone stepped back from the OR table.
Simarian pressed the button. Since Patty was paralyzed with the succinylcholine, there was no apparent effect from the electric current except on the EKG screen. The fibrillation disappeared, but when the phosphorescent blip returned, it did not show a normal heartbeat. Instead, it traced a completely flat line with only a few minor squiggles.
“Restart massagel” Jeffrey ordered. He stared at the EKG. He couldn’t believe there was no electrical activity. The muscu-
lar male nurse took over from Simarian and started compressing Patty’s chest with good result.
The fetal monitor was still sounding. The child’s heart rate was too slow.
“We gotta get the baby!” Simarian snapped again. He changed his gloves and hastily took additional drapes from the scrub nurse. He positioned them as best he could despite the cardiac massage. He grabbed a knife from the instrument table and went to work. Using a generous vertical incision, he sliced Patty’s lower abdomen open. With the reduced blood pressure there was very little bleeding. A pediatrician arrived on the scene and prepared to take the baby.
Jeffrey’s attention stayed with Patty. He suctioned her and was surprised at the amount of secretions even after the two doses of atropine. Checking
Patty’s pupils, he was pleased they were not dilated. In fact, he was surprised to find them pinpoint. With oxygenation remaining up, Jeffrey decided to hold off introducing any more drugs into Patty’s system until after the baby was delivered. Briefly, he explained what had happened to the nurse anesthetist.
“You think it’s a reaction to the Marcaine?” she asked.
“That’s all I can think of,” Jeffrey admitted.
In the next minute a silent, blue, flaccid baby was pulled from Patty’s abdomen. After the cord was severed, the child was quickly handed to the waiting pediatrician. He rushed the newborn to the infant care unit, where the baby was surrounded by his own resuscitation team. The nurse anesthetist joined that group.