I recently witnessed an awake intubation on an elderly female patient. The patient's dx was CHF and possible aspiration/pulmonary edema. After suffering from increasing respiratory distress while on the telemetry floor, she was transferred to the ICU. I had the opportunity to follow her progress. Within 30 minutes of entering the ICU, she underwent an awake intubation. Although she received approx 8 mg Versed and 2 mg morphine (I think?), there was no succinylcholine on the ICU floor, which is what the CRNA requested. Since the patient was rapidly desating and going into bradycardia, the CRNA made a decision to do an awake intubation. The patient was not paralyzed at this point. After intubation, the respiratory therapist assisted with respiration. Shortly after this time, the patient's belly significantly expanded outward and, while being suctioned, significant amounts of a pink, frothy substance was expressed. It even looked like there may have been tissue mixed in. The patient then coded twice.
My questions related to this experience are as follows:
1) is it typical to keep succ on the ICU floor for emergency intubation or do you use something else--perhaps Nimbex (sp?)
2) What is the significance of the belly expanding shortly after intubation and manual bagging? The CRNA was pretty confident that the tube was placed correctly since he didn't hear any gurgling in the LUQ.
3) How can you tell the difference between aspiration (that may have severely damaged the lungs) and pulmonary edema that was suctioned out in a profuse amount.
I really appreciate your analysis of this situation and look forward to learning from your comments. Thanks in advance, Stephanie
ok..first of all I graduated with my BSN in 1998 - so this spring i will have been a nurse for 7 years...and i am only in my first year (soon to be second) - secondly because you do not personally know me i will not hold your assumptions against you but chalk them up to ignorance. I have no need to pad stories - like just about every SRNA and CRNA out there I have strived for perfection and success my entire life. I have worked in between 10-15 ER/Trauma Centers - many of them at once... and scholastically I am privaledged to have amazing sites that provide me with a ton of experience with very little "problems" as many of my classmates have encountered at other facilities. You are correct - I haven't seen soldiers with injuries you mentioned - but i have cared for 12 y/o with their brains hanging out, infants who have been so critically injured by their own parents they have died, car accident victims with so many injuries it is a wonder they lived... so I have seen horror as well -yet it doesn't make me an expert - nor does it make you.
I thoroughly enjoy learning from my instructors when they are willing teachers rather than ... well rather than the type of CRNA you have come off as in your posts. I am sure you are an excellent provider - but you speak of me (directly) and other students (indirectly) as if you have any idea of how we practice or what we know or how we value learning. I demand 125% of myself at all times and my clinical staff as well as my didactical staff HAVE put that in writing. I have no need to embellish - and anyone who actually knows me would tell you that without blinking.... it is really sad that you function in such a negative fashion..
i will no longer respond - because this forum is for learning and not ignorant idle spats. good luck to you -
OK 1998 plus 7 equals 2005 (and being in school one year....just not possible). Right there is my point, why would you be untruthful about something a small as that (and then be unprofessional by "name calling").....Additionally, You seem to be making the same assumptions (about negativity).
I learn constantly from everyone (from the medic on the floor up to the hospital commander). My point is that being sure of yourself and your practice will speak for itself. I am saying the humility serves you well, this forums is entitled Nurse Anesthetist (CRNA) and many students speak as if they already are there..... I was there I know what your feeling and I have empathy, be able to take credit and criticisms when they come around. The posts speak for themselves (if you review them, I mean many and many of them then one can certainly get my point).
read the post correctly...it says that THIS SPRING (that is 2005) I will have been a nurse for 7 yrs. which by your flawless math is...hmmmm... 7 yrs. and one year of school...well last time i checked i am still a nurse...
so much for complete understanding of math + english.
read the post correctly...it says that THIS SPRING (that is 2005) I will have been a nurse for 7 yrs. which by your flawless math is...hmmmm... 7 yrs. and one year of school...well last time i checked i am still a nurse...
so much for complete understanding of math + english.
point proven - end of discussion.
My math is excellent why thank you. BSN in 98? Boards puts you at a license probably around august timeframe of '98.....orientation on a unit adds takes about another month....add on a year in school.....(get my point, we all have been there and been through it so we are not "ignorant")
Your assumption that I am ignorant is really unfounded....just because someone disagrees with you doesn't make them ignorant.
I hope you aren't this stubborn with your practice. Remember, this is a small community....... The attitude you are displaying would lend one to be resistant to work with you. If you come across a colleague or MDA or surgeon and say "end of discussion" then you have created a poor working environment. Taking discussions as personal attacks is the wrong answer.
My math is excellent why thank you. BSN in 98? Boards puts you at a license probably around august timeframe of '98.....orientation on a unit adds takes about another month....add on a year in school.....(get my point, we all have been there and been through it so we are not "ignorant")
Your assumption that I am ignorant is really unfounded....just because someone disagrees with you doesn't make them ignorant.
I hope you aren't this stubborn with your practice. Remember, this is a small community....... The attitude you are displaying would lend one to be resistant to work with you. If you come across a colleague or MDA or surgeon and say "end of discussion" then you have created a poor working environment. Taking discussions as personal attacks is the wrong answer.
mwbeah
430 Posts
I learn constantly from everyone (from the medic on the floor up to the hospital commander). My point is that being sure of yourself and your practice will speak for itself. I am saying the humility serves you well, this forums is entitled Nurse Anesthetist (CRNA) and many students speak as if they already are there..... I was there I know what your feeling and I have empathy, be able to take credit and criticisms when they come around. The posts speak for themselves (if you review them, I mean many and many of them then one can certainly get my point).
Mike