Quote from Diprivan/Vented
This morbidly obese lady (approx 550 lbs) self-extubated, and anesthesiology was called. Took them a while to re-intubate because when they went in to visualize, all they saw was soft tissue. They wound up having to reintubate with a combi-tube (sp?). The husband was adamant about not going through extreme measures to save his wife's life, and he distinctly said he did not want her trached. At that time, her k-level was around 4, but her INR was around 3.2. So yesterday (about 24 hrs posts reintubation with the combi-tube), the attending MICU doctor and the chief of anesthesiology at my hospital got together and made plans to attempt to reintubate with an ETT. I was the primary nurse for the patient, btw, and spent about 4 hours preparing the patient, getting lab values (k level was around 4.5, INR was around 1.7), ensuring the patient was completely sedated (I placed the pt on 300 mcg/hr of propofol and 8 mg/hr of lorazepam, v/s were wnl, and they even bolused her with about 5 cc's of propofol right before the procedure), and all the doctors were discussing how they would change out the tubes and getting their own equipment together. Then the big wigs of the entire medical center came in. Chief of Anesthesiology of the entire medical center, chief of anesthesiology of the medical school, chief of anesthesiology of the hospital, chief of anesthesiology of ob/gyn, Attending and Professor of MICU. Not sure if I got all the titles correct, but I know this case is about as serious as it gets as far as important people. Then they started the procedure, and it didn't even last maybe 10 minutes! When it was over, I was more baffled about it all. Can someone please explain what happened? I don't understand why they got all these chiefs in here for what looked like a really minor procedure. Sorry for my ignorance.
Ya know, when my 1st husband was in the hospital, dieing. He extubated himself (ETT). He was a DNR at the time, discussed at length with his attending because of our age.
When a redisdent, in the attendings absense decided to trach him when he extubated himself, I just happened to walk in. 6 months pregnate and not in the soundest of states.
I whacked that resident with the trach tray, in the nose. My first husband died 22 years ago in the 2nd. I wonder how that womans' husband is feeling now, his orders were not followed. How did she fair with the Tx?
I haven't worked a unit sisnce shortly after my 1st husband died, found it just too much for too long and LPNs are not generally welcome there anymore so I can not answer the questions about the tube choices, I am interested thought. I do follow (at least I try to) what's going on with updates.
My comment is more asking a question about the husband. Generally speaking, self extubation on a DNR = do no reintubate as intubation is an extrodinary measure in a non-emergency setting (emergency setting being the ER, OR before a DNR is signed). At least the courts agreed with me on that.