Published
I am an ICU RN... Scenario: Im at the bedside of a SCI patient with a halo who had hrs earlier been extubated and did not fly. 3 Anesth. residents show up for stat reintubation who all of which I knew b/c they had all previously rotated on-call through my unit (2 were 3rd yr and 1 was 2nd yr, I think). They set up a video assisted laryngoscope in preparation of a difficult tube placement. The meds were pushed and the pt was hyperoxygenated. Attempt #1- The resident at the head of the bed has a hard time finding the vocal cords and the pt begins to desat as expected. At 92 I begin to call out the pts sats and VS as any bedside RN should. As we approached mid 70's I began to call out with a more stern voice. At that point the pt began to drop rapidly and by the time I said "the patient NEEDS to be reoxygenated" the sat hit 40's. The resident tending to the video device immediately snapped back at me "THERE IS A TWO MINUTE DELAY ON THE MONITOR!" ...but my point was made and the scope was withdrawn and the pt was bagged back up. In that time I called my charge RN and told him I needed him over there ASAP. He got there, I gave a brief explanation of what happened. Attempt #2: Same issues as attempt #1 but my charge RN was calling out the VS instead. He began to "get stern" once the sat hit upper 70's and the same snappy resident barked at him " DO NOT CALL OUT ANYMORE!" Around the 60 mark, fortunately the cords were found, tube slid into place, placement verified, and pt once again being bagged back up.
First of all, I am aware that this is a difficult airway due to the halo. Second, I am aware that pts desat while being intubated. But in my (adequate) expierence, I have never seen an anesthetist let the sats approach 60 much less 40. To me, that just seems dangerous and had it not been for the bedside nurses, this pt would have probly ended up with a cerebral infarct.....Am I justified in feeling this way or stupid and this is common practice?????