My first uncontrolled intubation
Our new admit came in with respiratory distress taxing out her accessory respiratory muscles. I took one look at her and decided that she had impending respiratory failure so I grabbed the intubation box and called my nurses together and asked for the attending to be in the room.
She was full of more mucous than I had ever seen in my life. I could not suction enough out. I just kept taking turns between ventilating and suctioning. The venting also did not go well because I couldn't get a good seal because she didn't have teeth and every ventilation was accompanied by a gurgling of air escape.
I tried versed and my attending did not want to use a paralytic. Everytime I tried to open her mouth I was greeted with locked jaws and lots of mucous.
Everytime she began to desat a little I bagged her back up, air leak and all.
I finally tried propofol and she took a lot before I was finally able to open her mouth. What greeted me was lots of mucous to suction.
Her head had torticollis and she was in a C-collar so I used in line traction. Even with the less than optimal angles I found her epiglottis relatively easily with a mac 3, lifted and found tons of mucous in front of the vocal cords. I called for suction and cleared a path.
Then the cords - finally. The tube passed easily.
Her breath sounds weren't equal bilaterally and she was satting around 80% so I pulled out the ET tube a little and then her sats went up to 100% and the breath sounds became equal.
It was a tough first non-OR/anesthesia intubation I had done and it was tough.
She was full of more mucous than I had ever seen in my life. I could not suction enough out. I just kept taking turns between ventilating and suctioning. The venting also did not go well because I couldn't get a good seal because she didn't have teeth and every ventilation was accompanied by a gurgling of air escape.
I tried versed and my attending did not want to use a paralytic. Everytime I tried to open her mouth I was greeted with locked jaws and lots of mucous.
Everytime she began to desat a little I bagged her back up, air leak and all.
I finally tried propofol and she took a lot before I was finally able to open her mouth. What greeted me was lots of mucous to suction.
Her head had torticollis and she was in a C-collar so I used in line traction. Even with the less than optimal angles I found her epiglottis relatively easily with a mac 3, lifted and found tons of mucous in front of the vocal cords. I called for suction and cleared a path.
Then the cords - finally. The tube passed easily.
Her breath sounds weren't equal bilaterally and she was satting around 80% so I pulled out the ET tube a little and then her sats went up to 100% and the breath sounds became equal.
It was a tough first non-OR/anesthesia intubation I had done and it was tough.
posted by Henry NYC @ 2:37 AM
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