It seems that I've heard this more and more in the last few weeks.
Ex 1: unk amount of OD comes into a psych room (smaller, has all the appropriate equipment, but kind of tight). Pt will open eyes to pain or strong verbal. Decision made to intubate....that's fine, this patient obviously can't maintain his airway. ER MD, tech, and RT freak out, "We can't do this in here!" and decide patient has to be moved to a bigger room before tubing. They proceed to move patient out IN HIS UNDERWEAR and go past several hallway patients. Sats were 100%, it was a prophylactic intubation - not due to any emergent medical issue.
Ex 2: Mom w preterm labor coming in via EMS with known placenta previa. OB notified, ER physician insists patient be directly taken to L&D because "We can't deliver a baby in here." Um, we're the ER. We can handle it if the right people come down. Finally convinced MD we at least needed to check the baby first to ensure FHR still up. No, the ER isn't the best place to deliver a baby, but you can't take a mom upstairs (L&D is a 10 min walk) if the baby's HR is 70.
Ex 3: I'll spare the story, but it pretty much encompassed "We can't code this patient in here." Seriously. Would you like me to tell her to wait until we get a trauma room open?
What are people thinking? I'm an ER nurse, you're an ER MD. Give me the right equipment and we can tube in the bathroom if we need to. What drives me nuts is medics tube upside down in the rain, but my pampered docs can't handle it in a psych room.
Specializes in Critical Care, Emergency, Education, Informatics.
Good job doctor, RT, and tech for pushing to have a better area to perform an intubation, and I thought this was going to be another thread about a doctor making bonehead decisions. More working area, more space to manuver, additional space for equipment, and space for additional people should a difficult situation occur. I do not disagree with you co-workers decision to move.
You need to step back and rethink this casual attitude toward intubation. You want to give drugs that will take away your patient's ability to maintain any kind of airway, but want to complain about your co-workers wanting to perform the said procedure under optimal conditions?
This has nothing to do with medics intubating. Your comparision is invalid. We may have to intubate under suboptimal conditions in the field because we are forced to do so. This should not be the case in the emergency room. In addition, many EMS providers would rather intubate in the ambulance than upside down in the rain. I know I have done flights were we opted to move the patient to the ambulance and have a proper setup prior to RSI.
Somebody once told me the following: "RSI is one of the rare situations where you have a perfect chance at the clean kill." You do not cut the patient, bleed them out, or physically induce trauma. You put them to sleep, loose the airway, and have a clean looking corpse. Not something to phone home about.
Edit: Not trying to rip on you too hard, just want you to look at the big picture.
Speaking as someone who actually intubates in teh back of a small airplane, you DON"T need all that space. Were the problem comes into play is finding room for the Vent. If the bigger space was available, you go for it, if not you do it were you are. What will having a bigger room get the patient? Why is the smaller room considered sub optimal? it's perspective in most cases.
I've watched a second-year peds resident intubate a toddler with a critical airway in a single patient room containing two patients, the other an adolescent who was on a low air loss bed and also trached and vented. To get to the child's head he had to crawl between the other patient's ventilator and the pump tree of the crumping child, under the wall-hung monitor and a variety of tubing, cables and pieces of equipment at head of the bed. Why didn't the staff move the patient to where there was more room? There wasn't anywhere else they could have taken her in an overcrowded unit with very inexperienced management. It was about the worst in-hospital situation you could imagine. But we work in conditions like this every day.
I totally understand the OP's point of view, but I can also see the value in trying to optimize whatever factors one can.
Speaking as someone who actually intubates in teh back of a small airplane, you DON"T need all that space. Were the problem comes into play is finding room for the Vent. If the bigger space was available, you go for it, if not you do it were you are. What will having a bigger room get the patient? Why is the smaller room considered sub optimal? it's perspective in most cases.
I disagree. When I fly, I do everything possible not to intubate in the aircraft. If this means taking time at the hospital, that is what I will do. I would never knowingly place my self in a situation where I would intubate in the aircraft. Sometimes, the unexpected occurs however.
Again, read my prior posts. More space allows room to work, set up supplies, and manuver equipment. You should have all of your equipment out tested and mediations ready and labled. Your backups and surgical options should be ready and avaliable as well. The more space, the better. You can intubate under "sub optimal" conditions; however, is this really the best plan for the patient. Put ego aside and look at this from a patient care stand point.
Again, sometimes we are forced to work in less than ideal places; however, this was not the case with the OP. With that I understand the OP's frustration. ER docs dragging their heels as things back up. ER docs not getting out and making things flow. It truely is a PIA. However, the scenarios given were not the best examples IHMO.
In a beautiful shiney happy ER....everything works out exactly how we desgin it. Where is the beautiful shiney happy ER.....I do not think it exits....
CraigB-RN, MSN, RN
1,224 Posts
Speaking as someone who actually intubates in teh back of a small airplane, you DON"T need all that space. Were the problem comes into play is finding room for the Vent. If the bigger space was available, you go for it, if not you do it were you are. What will having a bigger room get the patient? Why is the smaller room considered sub optimal? it's perspective in most cases.