Fresh RSI & Vomitting

[airwick1987]

So i had a patient who was RSI'ed in the field. Shortly after arrival she began vomiting. the Team i was working with was very quick to turn the patient when she was vomiting. Is this the correct practice? What does evidence based practice say about endeavors when patient is vomiting with a cuffed tube? She didn't have OG inserted yet so my thought was okay lets just keep suctioning and insert the OG. I did some research and couldn't find much. Isn't there the theory of when repositioning the patient the pressure on the cuff changes too so we end up compromising airway even more? Would it be safe to assume that patient has a cuffed tube and that laying them supine and suctioning is sufficient? this patient was 350b. thanks any insight would be appreciated!

[MunoRN, RN]

Intubated patients can be turned onto their side if that is part of what you're asking. Intubated patients can vomit just like anybody else can, the goal when any patient is vomiting is to protect the airway, which is why we position the patient help keep vomit from going down the trachea. Having a tube and cuff in the trachea provides some amount of added protection, but certainly isn't aspiration-proof, the cuff doesn't provide a reliable barrier and it's pretty likely that anything ends up sitting on the cuff, including vomit, will eventually make it's way past the cuff. So keep what you can from getting down the trachea in first place and suction as much as you can of what did make it down there.

[roser13, ASN, RN]

RSI= ?

[JustBeachyNurse, LPN]

RSI= ?

Rapid sequence intubation

[That Guy, BSN, RN, EMT-B]

Intubated patients can be turned onto their side if that is part of what you're asking. Intubated patients can vomit just like anybody else can, the goal when any patient is vomiting is to protect the airway, which is why we position the patient help keep vomit from going down the trachea. Having a tube and cuff in the trachea provides some amount of added protection, but certainly isn't aspiration-proof, the cuff doesn't provide a reliable barrier and it's pretty likely that anything ends up sitting on the cuff, including vomit, will eventually make it's way past the cuff. So keep what you can from getting down the trachea in first place and suction as much as you can of what did make it down there.

Thats why there is a suction port just above on some tubes. To get those secretions/vomit out.

[MunoRN, RN]

Thats why there is a suction port just above on some tubes. To get those secretions/vomit out.

Those Evac tubes are pretty handy for secretions that settle on the cuff, although they aren't all that good with solids. I had a patient once who got intubated at the casino, and apparently they were having all-you-can eat shrimp night because I spent a good part of my shift fishing shrimp, some completely un-chewed off the cuff after she vomited them up. That little 14 french evac tube was no match for what was coming up from her stomach.