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"Ambulance Attendants Sued"
- Thread starter jochi1543
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Okay, I'm really curious as to HOW they could lacerate her spleen and poke a hole in her diaphragm while intubating her.:wacko:
medic417
The Truth Provider
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Wonder if any of theses damages actually occured in the wreck?
Now the missed tube left in place is inexcusable, if that in fact occured.
Now the missed tube left in place is inexcusable, if that in fact occured.
PapaBear434
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Wow. If that is true, it sounds like they REALLY sucked at their job.
I was wondering that myself. Used a 20 mm tube, apparently.
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Yeah, that's why I posted this here...we've been discussing it at my practicum, but none of us here are ALS, so we are not experts on the topic.
Epi-do
I see dead people
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I can't see how that would happen either. I mean, they would have not only misplaced the tube, but made it disappear altogether. (Not to mention the fact that there should have been a hole somewhere in her digestive tract as well, if this actually happened.) "And now, for my next magic trick...."
Aidey
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How long was that ET tube? Or were they trying to insert it in her belly button?
The misplaced ET tube sounds like it was possible. However for negligence they have to prove that the patient was damaged by the event, and by the sounds of her numerous other injuries they are going to have a hard time saying any brain damage she received was from a misplaced tube, and not from the accident.
The misplaced ET tube sounds like it was possible. However for negligence they have to prove that the patient was damaged by the event, and by the sounds of her numerous other injuries they are going to have a hard time saying any brain damage she received was from a misplaced tube, and not from the accident.
An adult ETT can be 33 cm in length plus up to an additional 4 cm for the connector. By 8 months of pregnancy the diaphragm may have risen as high as 4 cm from its normal position. With abdominal and diaphragm displacement of an eight month pregnancy, the damage mentioned here could be possible if the lady is relatively short.
Knowing the lengths of the ETTs is something everyone who intubates should know. It prevents you from ramming the thing in too deep and doing extreme damage. Also, if your tube is buried to the hub and has met not resistance, chances are you have entered the esophagus. There are other situations where you must be extremely aware of tube length when intubating people who have relatively short vocal cords–carina distance. This is particularly true in the Asian population. The ETT could be hitting the carina at 17 - 18 cm in some smaller Chinese adults while in others who are the same height would require a placement of 22 cm for correct tube position with 25 cm to the carina.
This is all just part of basic airway assessment that should be acknowledged before attempting intubation. You should already have a cm mark in mind before you stick a piece of fairly rigid plastic into someone's throat. You should also be aware of how long a 6.0 tube is before you attempt to nasally intubate someone who is 6 ft 4 inches. Chances are the cuff will not be below the cords.
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daedalus
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No good deed shall go unpunished.
Try and save a life and lose your livelihood. While VentMedic is on to something, I really really doubt that the ETT breached her spleen. Her brain damage and miscarriage were caused by the accident, not the paramedic's care.
Try and save a life and lose your livelihood. While VentMedic is on to something, I really really doubt that the ETT breached her spleen. Her brain damage and miscarriage were caused by the accident, not the paramedic's care.
Unrecognized intubation of the esophagus is enough to end this person's life or quality of life regardless of what damage was done to the spleen. This is the one thing that has gotten ETI taken away from some ALS services and have put procedures such as RSI into question because some EMS providers don't take the time to confirm correct tube placement even if they do have the equipment.
When you become a medical professional, you will be expected to be accountable for your mistakes. This is where you will learn the differences between errors that can be corrected or do little harm and mistakes that cause permanent damage and/or death.
If you do more damage by not doing your job correctly, you have done harm and have done very little to save that person's life.
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Vent,
Please correct me if I'm wrong, but even IF the diaphragm is moved up due to pregnancy, and even if the patient is short, how could they put a hole in the diaphragm while intubating, regardless of whether or not they were in the trachea or not? Wouldn't they have to punch through the trachea or esophagus first, in order to get to the diaphragm?
Please correct me if I'm wrong, but even IF the diaphragm is moved up due to pregnancy, and even if the patient is short, how could they put a hole in the diaphragm while intubating, regardless of whether or not they were in the trachea or not? Wouldn't they have to punch through the trachea or esophagus first, in order to get to the diaphragm?
Aidey
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Yeah, it seems like they would have to push the ET tube through a lot, and it would take quite a bit of force even if it is physiologically feasible.
Epi-do
I see dead people
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It is not that difficult to tear the esophagus even with just a misplaced tube. And no you don't have to go through the wall of esophagus and then into the trachea to get to the diaphram. The angle of the stylet will determine the direction and the damage.
One can also go through the tracheal wall into the esophagus. This was even discussed on this forum at great length in the "Blew up like a balloon" thread. These are all complications that should have been taught to you when you were learning to do ETI.
daedalus
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Vent, I am not saying that they should not be held accountable for an unrecognized esophageal intubation, but that this women's claims seem outlandish. I agree with the above, the tube would have to puncture the trachea, bronchus or esophagus, than puncture the diaphragm, and than enter the spleen.
No, it doesn't take much force to damage internal tissues especially with an ETT and stylet.
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Okay, that makes sense...but they would still have to tear through one or the other, and if that was the case, I think it would have been mentioned in the article.
Is it really necessary to publish the entire autopsy? I think the real issue here is the lady is FUBAR as the result of a misplaced tube.
daedalus
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Wait, did she die?
If the tube goes into the esophagus, with a slight angle on the stylet and tube, it can easily pierce the esophagus and diaphragm with the displacement from the pregnancy. The Paramedic may not have been expecting such a displacement and may even have given an extra "push". I have seen way too many providers grip an ETT like they are stabbing something rather then gently advancing.