Missed a tube, twice.

[rhan101277]

Well I had a cardiac arrest this weekend, could not get the tube. Huge amounts of emesis, even chunky at time. Couldn't see the cords, tried a combitube but felt like I would have to really force it. I went with oral airway and BVM.

 

[Shishkabob]

If it works, it works.

 

[usalsfyre]

Better to miss a tube and go with BLS methods than not recognize the tube's in the wrong place. Did you happen to have powered portable suction at bedside?

As an aside I recommend any new medic try to view the Airway Cam video series, it gives you a much truer look at anatomy than mannequins or text books, and 80% of laryngoscopy is identifying anatomy.

 

[WTEngel]

I personally would never come down on someone for missing a tube. It happens. If someone brought in a patient and swore up and down the tube was good, and it wasn't, I would take major issue with that.

Now if a medic misses their tubes more often than not, that is a pattern that needs remediation.

 

[usalsfyre]

I personally would never come down on someone for missing a tube. It happens.

I had an instructor that was fond of saying if you've never missed a tube, you haven't intubated enough to have an opinion.

 

[WTEngel]

That sounds like a well rounded and experienced opinion. Strange coming from an instructor!

I read over my previous comment and thought I should clarify a little bit. I don't want to sound as if missing a tube should be taken lightly. Medics need to be spot on when it comes to the skill of intubation. I understand that every airway can not be successful though.

I really feel like providers who judge fellow providers based on number of tubes, successful tubes, etc. have a pretty narrow view. I think the true test of a provider comes when the advanced airway is not obtainable, and how quickly you can think on your feet, take a big breath, and fall back to reliable BLS methods to keep that patient alive.

 

[rhan101277]

Better to miss a tube and go with BLS methods than not recognize the tube's in the wrong place. Did you happen to have powered portable suction at bedside?

As an aside I recommend any new medic try to view the Airway Cam video series, it gives you a much truer look at anatomy than mannequins or text books, and 80% of laryngoscopy is identifying anatomy.

Yeah I viewed those videos, but anatomy was unrecognizable. I did have battery powered suction, but it would just keep coming. I did continue to suction throughout. It was a big patient who apparently just ate a whole bunch of some type of soup. I will take it as a learning experience and strive to do better. School isn't bad when its a dummy, or when you are doing clinicals and a whole group of people are there. When it is just you and your partner, its tough to get everything done that needs to be done. I didn't have time to print out every strip, I did have any rhythm changes anyhow. I am sure it will get audited and things pointed out where I could have done better.

It took the doctor three attempts. I did the best I could. He had heart problems and was prescribed viagra, which didn't make since.

 

[8jimi8]

Yeah I viewed those videos, but anatomy was unrecognizable. I did have battery powered suction, but it would just keep coming. I did continue to suction throughout. It was a big patient who apparently just ate a whole bunch of some type of soup. I will take it as a learning experience and strive to do better. School isn't bad when its a dummy, or when you are doing clinicals and a whole group of people are there. When it is just you and your partner, its tough to get everything done that needs to be done. I didn't have time to print out every strip, I did have any rhythm changes anyhow. I am sure it will get audited and things pointed out where I could have done better.

It took the doctor three attempts. I did the best I could. He had heart problems and was prescribed viagra, which didn't make since.

Viagra can also be used for blood pressure control.

Not to mention, many people have different doctors for different problems. The two doctors may not be on the same page.

 

[WTEngel]

Using Viagra for erectile dysfunction was originally an off label use believe it or not!

Viagra was originally used quite frequently in NICUs to assist in controlling pulmonary hypertension among other things.

Funny side note. A new nurse was asking why one of the neonates had a profound erection. I told him that the physicians ordered for Viagra from time to time. The nurse looked at me pretty clueless for a moment and asked "Why?"

I told him with an absolutely straight face that it kept the babies from rolling out of the bed if we forgot to put the rails up.

That story is somewhat legendary...just saying.

 

[Aidey]

Viagra can also be used for blood pressure control.

Not to mention, many people have different doctors for different problems. The two doctors may not be on the same page.

Yeah, and no guy has EVER lied in order to get it up.



"No Doctor, I don't have any problems with my heart or blood pressure"

 

[dixie_flatline]

Using Viagra for erectile dysfunction was originally an off label use believe it or not!

Viagra was originally used quite frequently in NICUs to assist in controlling pulmonary hypertension among other things.

Funny side note. A new nurse was asking why one of the neonates had a profound erection. I told him that the physicians ordered for Viagra from time to time. The nurse looked at me pretty clueless for a moment and asked "Why?"

I told him with an absolutely straight face that it kept the babies from rolling out of the bed if we forgot to put the rails up.

That story is somewhat legendary...just saying.

I wish I could give you +rep or something for that. The joke is great, but I also love the phrase "profound erection". Sounds like serious business.

 

[usalsfyre]

Yeah, and no guy has EVER lied in order to get it up.

I thought that was the primary reason you were supposed to lie when your single and under the age of 22 .

 

[Veneficus]

prozac and viagra,

The ultimate cure for depression.

If I could offer some advice?

Do not try to hurry and get everything done at once.

If your patient is in cardiac arrest, think slow, act deliberately. There is no task other than the one you are performing at that moment.

If CPR is in progress, all is well.

If the monitor is attached and a shock indicated, perform it.

If no shock, control the airway.

If you get all that done, start a line. We know the drugs aren't critical to success, CPR defib and airway are. If the line doesn't get started, oh well.

Don't be in a rush, the patient is dead.

field tip: When I was the only medic I liked to take an IV needle with me to the head. Tube the patient, secure the tube, then start an EJ. With hands free pads and a drug box, I never had to move the entire code.

Elegance...

 

[usalsfyre]

field tip: When I was the only medic I liked to take an IV needle with me to the head. Tube the patient, secure the tube, then start an EJ. With hands free pads and a drug box, I never had to move the entire code.

Elegance...

I used to do this pre-King airway and EZ-IO days. However, now I just have to be somewhere near a leg, anyone can control the airway.

 

[Shishkabob]

I go to the leg, do the IO and have the monitor next to me, and have my EMT go for the airway with the King. I only move if I have to do the airway myself with an ETT.

 

[Veneficus]

I go to the leg, do the IO and have the monitor next to me, and have my EMT go for the airway with the King. I only move if I have to do the airway myself with an ETT.

damn kids

 

[abckidsmom]

damn kids

Remember when ACLS scenario arrests seemed so unreasonably quick, and in 5 minutes you could run through the entire algorithm? Now in real life, that's how long it takes. The IO and airway only take as long as it takes to get the stuff out of the bag and set up the line. 10 minutes, tops.

I remember working 45 minute asystole arrests back in the day. With 20 minute response times. Cause we were "heroes" and stuff.

:shakes head:

 

[firetender]

There's only practice

the important part of this is the recovery. You have protocols and what you're taught and then you have the situation. Your situation demanded getting back to a more basic approach. The Doc making three attempts himself tells you expertise didn't make much of a difference in that case.

Maybe I would have treated this like a drowning and seeing all this soup coming up incessantly, rolled him over on his side and given him a few thrusts to the belly in an attempt to relieve some of the pressure before I got back into his throat. Maybe, I said. I wasn't there and you were.

I think your judgment was fine and besides, handling difficult cases builds critical skills fast; regardless of success or failure.

And at the risk of bringing up Viagra again (roll eyes!), I never understood why, when the drug company started to advertise it to the general public they didn't just use their own warning as the HEADLINE: "If erection persists longer than six hours, call your Doctor." In fact, who would need any more information to make a buying decision?

 

[Veneficus]

Remember when ACLS scenario arrests seemed so unreasonably quick, and in 5 minutes you could run through the entire algorithm? Now in real life, that's how long it takes. The IO and airway only take as long as it takes to get the stuff out of the bag and set up the line. 10 minutes, tops.

I remember working 45 minute asystole arrests back in the day. With 20 minute response times. Cause we were "heroes" and stuff.

:shakes head:

Yea.

When A medic who could show up on scene, intubate, start a line, defib 12 times, and between pour every drug into the IV from epi to mag sulfate all under 15 minutes was a master of the trade.

On a corpse that had been dead for hours.

Then load the guy up and CPR him all the way to the hospital while tearing down the 25MPH road at 50 MPH only to get to the hospital where the ED doc pointed out the pt. had rigor.


The good old days... Hard to believe some of those patients survived in spite of all we did.

Living the dream...

 

[Veneficus]

And at the risk of bringing up Viagra again (roll eyes!), I never understood why, when the drug company started to advertise it to the general public they didn't just use their own warning as the HEADLINE: "If erection persists longer than six hours, call your Doctor." In fact, who would need any more information to make a buying decision?

As an author, you of all should know...

There's no publicity like bad publicity.

From Les Miserables to Harry Potter, if it is the evil devil's work, it is better than gold!