Quote from getoverit
knowing when NOT to intubate a patient is much more important than learning the skills involved with passing a tube. .
I have to disagree a bit. It should not be a matter of knowing when NOT to intubate, but rather WHEN to intubate. And i think there IS a difference. In fact I taught my paramedic students to evaluate EVERY patient FIRST as to whether they needed intubating..or maybe we should say 'airway intervention' since there are a number of airway adjuncts and procedures to choose from these days. Early intubation in cardiogenic pulmonary edema, esp. fulminating, is likely one of the life saving and outcome improving pre-hospital uses of the endotracheal tube. It most often must be accomplished with a breathing fighting patient via the nasal route and it is truly an art as much as a skill. the patient should be sitting straight up...accommodate their desired position to get air... talk them thru it....tell them the tube will be uncomfortable but will help them breath easier..
U move WITH the patient to ease it in...talking the whole time. There is often little opportunity for niceties like serial dilations, neosynepherine soaked gauze, etc. These patients, in this extremis, if not nasally intubated will quickly tire, become severely hypoxic and will race you to their arrest before you can orally intubate them once they become so hypoxic they have little gag reflex. when the OP was describing his run I went back in my mind 20 years to my medic days and a particular patient who I was certain was vomiting through their nasal ET I just placed before I quickly realized that that huge amount of pink liquid was from the lungs.
After the nasal use whatever PPV you have working with their resp rate...hyperventilate them, u soon overpower their resp drive and they relax from exhaustion and let you ventilate them. As long as they are hypoxic however they will fight you and the tube. Bag the crap outta them before taking them down the stairs etc.
Either trach cloth "tape" or kling to secure the tube around the entire head.