What’s an intubation attempt?

[NomadicMedic]

If you put two medics in a room, they’ll find something to argue about. The latest ridiculous debate? What constitutes an intubation attempt. I believe that whenever the laryngoscope blade passes the teeth, with the intent to manage the airway, it is considered an intubation attempt. If you put the blade in the mouth, you should be prepared to pass the tube. Obviously, using a laryngoscope and Magills to clear an FBAO is NOT an intubation attempt. But, there’s no such thing as “just taking a look”. If you need to suction, suction. Practice progressive epiglottiscopy and identify what you see. Then, either place the tube or use an SGA.

 

[E tank]

If you put two medics in a room, they’ll find something to argue about. The latest ridiculous debate? What constitutes an intubation attempt. I believe that whenever the laryngoscope blade passes the teeth, with the intent to manage the airway, it is considered an intubation attempt. If you put the blade in the mouth, you should be prepared to pass the tube. Obviously, using a laryngoscope and Magills to clear an FBAO is NOT an intubation attempt. But, there’s no such thing as “just taking a look”. If you need to suction, suction. Practice progressive epiglottiscopy and identify what you see. Then, either place the tube or use an SGA.

Any maneuver to intentionally place a tube between the vocal cords, with or without DL, is an attempted intubation.

 

[TXmed]

The whole "just taking a look" mindset is just an excuse. Its an out so ****ty medics can feel good about themselves.

 

[Carlos Danger]

I have never liked the definition of "when the laryngoscope enters the mouth" because, even though I can't think of many scenarios where you would place a laryngoscope blade in someone's mouth without intending to intubate, it is entirely possible that someone somewhere might do it for some reason. I've seen people use a miller blade as a tongue blade to assist in placing an LMA, for instance. The other side of the coin, as E tank alludes, it that there are also ways to attempt an intubation without placing a laryngoscope blade in the mouth at all. So even though the "blade entering the mouth" definition probably captures enough attempts to be useful, given the importance that we attach to the number of intubation attempts, I think we need a less clumsy and more precise definition. "Any attempt to place an ETT between the cords" is a better definition, IMO.

At the risk of opening a big can of worms, I think the emphasis on limiting attempts for the sake of limiting attempts is misguided, because it shifts the focus from controlling physiology to controlling intubation attempts. I know that increasing numbers of attempts are associated with worse outcomes, but those poor outcomes are not caused by the number of intubation attempts, they are caused by the physiological response to repeated intubation attempts. Make your first attempt your best attempt, every time, but if you encounter trouble your immediate response should be to maintain homeostasis and formulating a plan, not focusing on how many attempts have already been made.

 

[hometownmedic5]

I agree with "any attempt to pass a tube between the cords" as the most correct. Digital intubation for example would not involve a blade.

I also agree with your opening line, and would go one step further to say that not only can we argue about anything, we also tend to have more opinions than participants in the argument. 3 medics, 5 opinions....

 

[CALEMT]

I was always taught when the tube enters the mouth. But I can't see a reason why "taking a look" doesn't constitute as an intubation attempt. Personally I've always counted anytime a Mac blade enters the mouth as an intubation attempt.

 

[StCEMT]

I was always taught when the tube enters the mouth. But I can't see a reason why "taking a look" doesn't constitute as an intubation attempt. Personally I've always counted anytime a Mac blade enters the mouth as an intubation attempt.

Use Millers then. Got it.

 

[Doomedtheory]

Training wise, I’ve heard an instructor say before that as soon as the scope or tube touches the patient.

 

[Tigger]

We are currently using "when the blade passes through the teeth with the intent to intubate." I think this is just a way to screw with the numbers and make it seem like we have a very high first pass success rate because our misguide management think that this the only stat that matters. If I put the blade in, I am prepared to pass the tube. Sometimes, that doesn't happen because sometimes there is something that forces an adjustment. I feel it is much better to quickly recognize that your plan will not succeed rather than making a very long single attempt because you don't want to document two attempts.

 

[MSDeltaFlt]

Blade passing the teeth PERIOD. No ifs, ands, or buts.

 

[Carlos Danger]

Blade passing the teeth PERIOD. No ifs, ands, or buts.

So it's not an intubation attempt if I do a blind digital, since no blade is entering the mouth? And it IS an intubation attempt if I'm using a straight blade as a tongue blade?

 

[MSDeltaFlt]

Touche'

Poor word choice.

Using direct laryngoscopy passing the blade pass the teeth PERIOD.

Using any other technique to pass an ETT is also considered an attempt: nasal, digital.

 

[TransportJockey]

For us here it's placing a blade of any type past the teeth with the intent of securing an airway with an ETT

 

[Carlos Danger]

Touche'

Poor word choice.

Using direct laryngoscopy passing the blade pass the teeth PERIOD.

Using any other technique to pass an ETT is also considered an attempt: nasal, digital.

Not trying to be a smartass; just pointing out why I don't like a strict adherence to the "blade passing the teeth" definition.

 

[MSDeltaFlt]

I'm not hating. I just don't believe in "looking".

 

[VFlutter]

Not trying to be a smartass; just pointing out why I don't like a strict adherence to the "blade passing the teeth" definition.

I also do not like the strict definition. A Laryngoscope can be a great tool while suctioning or placing SGA and OGs.

 

[CANMAN]

I also do not like the strict definition. A Laryngoscope can be a great tool while suctioning or placing SGA and OGs.

With any SGA airway I place a laryngoscope is utilized to aid in tongue displacement. Glad to see other people doing it to. It's a foreign concept to any medic I have interacted with on scene calls or in the field around my way.