Intubating without Ventilatory Assistance

[usafmedic45]

The tube was left open to air with oxygen provided by blow-by. The patient was breathing 10-12 times per minute with good chest rise and a SpO2 of 98% on oxygen.

If he were my medic, he would be suspended without pay pending disciplinary action against his license. The resistance of breathing through the tube alone makes what you described a very bad idea and I would eat him alive for it, both as a supervisor and as someone who is an admitted expert witness for court cases. The reasoning for the intubation is completely sound, but the execution of the procedure was exceedingly stupid.

For reference, the crew did not have a ventilator of any sort, nor waveform EtCO2 available to them.

If you don't have waveform ETCO2, perhaps you should be restricting your practice to non-visualized airways.

Unfortunately the initial cost is prohibitive to us currently, and administrators don't see it as a need because our medical control authority doesn't require it.

Then you probably should be relying on LMAs and Combitubes.

Sounds like a way to increase dead space - stick a tube in, blow up the cuff and don't add 100% - the adult pt now has a child sized airway with only their own ventilation's.

Dead space isn't going to be much of a concern since the tube is actually smaller than the diameter of the airway itself. The bigger problem is the increased resistance and I believe this is what you are trying to get across.

 

[Fox800]

I agree with what's already been posted. It's an exceedingly stupid idea to intubate a patient and leave the tube open to the air/place a nonrebreather on it. The intubated patient needs to receive ventilation from a BVM/ventilator, no questions asked. Also, intubating without ETCO2 waveform equipment available is very dicey, we would be decredentialed/suspended for doing any of this. We are required to verify ETCO2 waveform for any advanced airway placement, be it ETT or rescue airway (King LT), and I ALWAYS have it on the BVM even when I'm using that by itself.

 

[somePerson]

woah

I was reading trough this and I realised it took two pages of posts for someone to point out why not ventilatig the pt. with a BVM is a horrible idea. Common sense, breathing trough an ET tube without assistance is like trying to breath trough a slightly over-sized drinking straw.

 

[JPINFV]

I was reading trough this and I realised it took two pages of posts for someone to point out why not ventilatig the pt. with a BVM is a horrible idea. Common sense, breathing trough an ET tube without assistance is like trying to breath trough a slightly over-sized drinking straw.

Try post number 5 in the thread...

As to the original question, doesn't the increase in conduction airway and decrease in cross sectional area that having an ET Tube in place means that ventilation assistance would be a best practice? After all, just because you're using a BVM doesn't mean you can't synchronize squeezes with the patient's respiratory effort.