Friday, November 26, 2010

First Preventative Intubation

Well, I hit a milestone today. I intubated my first patient for preventative measures today as an attending emergency physician. Basically, this means I passed a tube down the patient's trachea to secure his airway because there was a high chance he would go into respiratory failure. He was a young teenager with symptoms of stroke and he was rapidly declining. We needed to get him to an ICU at another hospital fast and helicopter was the mode of transport chosen. I have intubated plenty of people, but most of the time they were unconscious, code situations, and it was a life-saving maneuver. This time, I was taking the patient from a fairly stable (currently) situation and paralyzing him (taking away his ability to breathe on his own), to passed the tube in.

It was a scary feeling, knowing that he could die in front of me, and I had no other MD in the hospital for back up in case something went wrong let alone an attending doc to ask questions...I was it. Whoa, the adrenaline was pumping, my arms were shaking, and as the nurses prepared the induction medications and the RT prepared the vent and intubation kit, I slipped away to my computer and prayed to God for guidance. I knew it was going to be difficult because the family insisted on staying for the procedure (added pressure) and the boy was over 300lbs (difficult to maneuver his neck).

After the meds were in, I positioned the head, inserted my mac blade and searched for the vocal cords, which I barely saw after about 10 seconds of readjusting. For some reason the endotracheal tube wasn't wanting to pass through the cords as they spasmed with each contact. After about 45 seconds of trying, the pt's O2 sats started to decline, so we bag-masked him for about 1.5 minutes to get his O2 sat back up and to get a smaller tube to try to pass. On second attempt, instead of trying to jam the tube pass the cords, I twisted the tube as it touched the cords and waited for the cords to relax and slowly passed the tube...SUCCESS! what a great feeling. My nurse and RT confirmed the positioning, secured the tube and worked effortlessly to get his parameters to the right levels. The life-flight crew was present within 10-mins of the intubation, packed him up and he was on his way. The adrenaline slowly started to dissipate as the situation stabilized.

What did I learn your team, trust your skills, and trust that God is in charge. I started my day with a prayer today that God would give me the ability to accomplish the things he would place before me today. Prayer answered. Time to get some sleep...until the next patient.

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