Last week I had, for once, a very sick patient. His wife called us for his shortness of breath. When I saw him, he was sitting up leaning over his knees, pale as a ghost, awake, and breathing, but barely. Within a minute of our arrival, he stopped breathing altogether and started to go sideways onto the couch. Thankfully there were three of us there to drag him unceremoniously off the couch and onto the floor. It was now we could see he had a trach. I was so glad to see it, as given this patients size, he would not have been easy to tube. The only problem with the trach, as we discovered, was that it was not compliant with our BVM which is absolutely ridiculous, and meant that we could not easily ventilate him. We ended up capping the trach and bagging him the old fashioned way. This obviously worked as he began to be combative as his brain got more oxygen. By then I had an IV in him that was threatening to be pulled out, and he had gone into runs of V-Tach (a deadly heart rhyt...