Failed Intubation Attempts

• Previous message: Failed Intubation Attempts
• Next message: Prevetable death? from a Qc MD
• Messages sorted by: [ date ] [ thread ] [ subject ] [ author ]

It may be worse...

If I intubate, and misplace the tube, some papers will show this as a
success, so long as I do it first time.

If I get it right, then as I struggle to get the patient downstairs I
displace the tube, yet because I am conscientious and have an end-tidal CO2
monitor, so recognise this almost immediately and re-site the tube, some
will consider it as failed.

Which will be worse for the patient?  I struggle to get the tube in the
first instance, or I fail to recognise that it is misplaced / displaced?

Do we need two standards here?


-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of CyBerg66 at aol.com
Sent: 23 March 2009 23:54
To: trauma-list at trauma.org
Subject: Re: Failed Intubation Attempts

 
As an anesthesiologist, I am unaware of a universally accepted definition  
other than the inability to intubate after multiple attempts. This
definition of 
 failure, taken from the ASA's Difficult Airway Algorithm, is useful
because 
it focuses on the end result. If it took several laryngoscopies and  
different techniques to intubate but the intubation was successful and the
patient 
survived without significant morbidity, the event would be characterized  as

being difficult rather than a failure. 
 
Where hard numbers are incorporated into recommendations published in the  
literature, I get the feeling those numbers are there to give providers a
way of 
 justifying to themselves when it's OK to change their plan and use an  
alternative approach. The hardest part of a surgical airway sometimes is
making  
the decision to give-up on Plan A and pick-up the knife. 
 
 
Curt Bergstrom, MD
 
 
In a message dated 3/24/2009 3:12:21 AM West Pacific Standard Time,  
rangraj at gmail.com writes:

Keith,  the ASA guidelines and definitions are attached.Kovacs and Law in
their  text Airway Management in Emergencies  (
http://books.google.co.in/books?id=8DVZt63PRLgC&pg=PA204&lpg=PA204&dq=failed
+i
ntubation+definition&source=bl&ots=tM1J18SAXA&sig=zkirx3ZjV6wWwlSv0fBIiR_EC5
g&
hl=en&ei=5cHHSdjNApSM6gOx7KXBBw&sa=X&oi=book_result&resnum=3&ct=result)<http
:/
/books.google.co.in/books?id=8DVZt63PRLgC&pg=PA204&lpg=PA204&dq=failed+intub
at
ion+definition&source=bl&ots=tM1J18SAXA&sig=zkirx3ZjV6wWwlSv0fBIiR_EC5g&hl=e
n&
ei=5cHHSdjNApSM6gOx7KXBBw&sa=X&oi=book_result&resnum=3&ct=result>
mention
three  attempts as the definition of failed intubation.rangraj

On Mon, Mar 23,  2009 at 9:49 PM, Keith Lamb <lambrrt at gmail.com> wrote:

> Is  there a universally recognized guideline of what constitutes a "failed
>  intubation"? There seem to be many opinions. I have heard a couple
>  recently,
> and am interested in your opinions.
>
>  Example:
>
> 1) introduction of the laryngoscope without placement  of ET = failed
> attempt.
>
> 2) 3 introductions of scope  without placement of ET OR
disrythmias/profound
> desaturations during  attempt etc etc. = failed attempt.
>
> It seems intuitive that any  attempt at placing ET without success is a
> failure. However you can  see that opinions vary and for QUALITY ASSURANCE
> purposes I am looking  for a specific definition, as to what constitutes a
> failed "attempt",  when should the intubator move to another adjunct
> approach, and when  should another intubator take over and attempt
>  intubation.
>




**************Feeling the pinch at the grocery store?  Make dinner for $10
or 
less. (http://food.aol.com/frugal-feasts?ncid=emlcntusfood00000001)
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/

• Previous message: Failed Intubation Attempts
• Next message: Prevetable death? from a Qc MD
• Messages sorted by: [ date ] [ thread ] [ subject ] [ author ]