Bad Things to See March 27, 2008
Posted by keepbreathing in airway management, respiratory therapy.trackback
When you’re looking down a laryngoscope, and you pop the epiglottis out of the way and you see the vocal cords, you feel good. “Look, here I am!” says the trachea. “I’m right here! Put a big plastic tube in me!” That is a happy feeling, and when the big plastic tube goes through the cords you feel good. No matter what else may be happening, the airway is secure, and that’s important.
But it is not always so nice. For example, you might insert the tip of the laryngoscope right into the vallecula and lift the epiglottis gingerly out of the way, only to see a giant puddle of green liquid rushing up the laryngoscope at you. If you’re extra special lucky, you’ll see the puddle of green liquid go swirling down between the vocal cords as you desperately suck pure bile out of your patients throat with a yankauer.
But despite it all you might see the tube go in. The tip will go through the vocal cords, and then the cuff, and then the markings as you advance the tube to the appropriate depth. This will make you very happy. But then you may see a thing which makes you sad, which is vomit shooting from the ET tube; this will be followed by an intensivist pulling the tube out because “there’s no way there’s that much vomit in the lungs.”
You win some, you lose some.
Well, not so fast.
will ebb and flow with inspiratory effort.
If it’s in the trachea, the “spew”( it’s an “industry term”
If it’s in the esophagus, and there’s a gastric decompression type flow of vomit….leave the tube in for a bit, ’till the tide goes out. As tempting as it may be, don’t give in to the temptation of aiming the tube at someone you are displeased with. It’s bad manners, and OSHA unfriendly.
Leaving the esophageal intubation in place for that moment will leave all that vomit on the floor, and not in the pharynx..into which you are about to try to look into again, and where the massive aspiration potential smells and looks as bad as it is.
AJC
I find it hard to function most days. Having OCD may well be the reason why