I wrote this piece to explain some of the terms that are commonly used by physicians, nurses and respiratory technicians in the ICU to describe some of the procedures and phrases that are used during the everyday ICU environment. I must say however, that most of the time, physicians are primarily guilty of using these words and phrases because nurses and technicians are just nicer people in general. While readers without a medical background may consider these terms irreverent or disrespectful, trust me, they are not meant to be, and simply make communication easier and perhaps a little lighter for the medical staff when they communicate with each other during the stressful situations in the ICU. I am honored to work with hard working, skilled professionals who show the utmost respect to their patients and I should know, because they saved me once a few years ago. I have written a similar book for patient families that describes common medical terms and procedures used in the ICU, however, it does not use the vernacular commonly used between staff, because well, it shouldn’t. This small piece may prove useful for ICU staff who are new to the job and still wet behind the ears and hopefully will make their time on the job much more pleasant during times of stress.

Here is a fictional teaching case: Mr. SmithJonesAwalski is a 55-year-old obese male who is brought to the ICU for failure to thrive and hypoxemia because of pneumonia and the TFTB syndrome. His wife states that he previously had a history of a hostile abdomen, however, his abdomen is quite peaceful now. He recently had an episode of explosive diarrhea however, this has now been safely diffused. She mentioned that he had a sleep study showing sleep apnea, and the technicians and physicians wrote that he demonstrated heroic snoring, although his wife preferred descriptors such as freight train or house – shaking snoring because she was sure she never saw his snoring save anyone with heroism.

Hospital course:

The patient was brought to the ICU and placed on the ventilator successfully. Due to significant mucous plugs, he required toilet Bronchoscopy on several occasions. He improved nicely and by the second day his sedation was removed and the staff began the Dumbo -ing process per protocol to see if he would fly. After he failed Dumbo -ing, the physician then ordered a quick Cowboy Extubation. The patient did well and was sent home in excellent condition due to the prompt and skilled attention he received from the ICU staff.

Definitions:

Toilet Bronchoscopy: According to the Oxford Textbook of Critical Care, critically ill patients retain secretions. Toilet bronchoscopy is applied to aspirate retained secretions and revert lung atelectasis. Basically, what this means is mucous plugs obstruct the lung bronchi or pipes of the lung, causing lung collapse or difficulty breathing. What does this mean in layperson’s terms? It means sucking out buggars and snot from the airways to improve breathing. Thus, the terms toilet and flush. Please remember that bronchoscopes are always sterilized completely after each flush.

Failure to Thrive: Self-explanatory I think.

Hostile Abdomen: There is no dictionary definition to refer to here. This is a term I learned from the general surgeons who have kept the term close to their scrubs I guess, until it was recently released and is now no longer considered top secret classified information. Basically, it refers to an abdomen that has unfortunately required multiple surgical procedures over time and therefore has adhesions and scar tissue making it more difficult for the surgeon to re – enter the abdomen if needed because the abdomen becomes very angry and pissed off when cut on again. We all try to keep abdomens as peaceful as possible and avoid hostility.

Explosive diarrhea: Well I think everyone understands explosion/explosive with respect to bombs and blowing things up etc., so I guess this is self – explanatory. Kind of similar to what is experienced when you drink Golytely for a bowel prep before a colonoscopy.

Dumbo -ing: This refers to the 1941 Walt Disney movie: Dumbo the Flying Elephant. Dumbo was an elephant and therefore not skinny, and he tried and tried but eventually learned to fly that heavy body with his large ears for wings. It refers to a patient who is quite overweight and sometimes they don’t breathe well because it is harder for the lungs to breathe when they have well, a sack of potatoes sitting on top of them. This is a variant of the TFTB syndrome (Too Fat to Breathe). Excess size may cause Dumbo not to fly when he is given the chance to breathe on his own off the ventilator machine.

Cowboy Extubation: No of course doctors, nurses and technicians do not wear cowboy hats in the ICU! It simply means we think cowboys are kind of wild and impulsive for unclear reasons, and this may not be based on any factual evidence. Maybe it just sounds good. So basically, it means if a patient is not flying off the ventilator while the tube remains in his/her trachea, and becomes anxious, and then the doctor gives an order to remove the tube anyway without waiting, because the patient may in fact, do better without the tube in. Perhaps there are real cowboys reading this who will be offended by this silly use of their heritage/occupation but no offense intended. Maybe we should instead call it instead, Politician Extubation.

TFTB: This is the basis behind the difficulty with Dumbo – ing.

Politician Extubation: Please see discussion under Cowboy Extubation.

© SRCarson Publications. 2017