social intubation?

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Note : I am not a nurse, but a medic but have worked in level one trauma center in that capacity

I was reading a post in another site and it brought up a valid question in my mind from when I worked in ER. I saw many patients intubated (RSI) for the convenience of the physician and staff if they were obnoxious. This included drunks and just downright difficult people sometimes with relatively minor problems. More than once I heard the comment "settle down or I'll put you down !" and it was done. What is your experiences with this and how do you feel about it? Do you ever question the docs when they do this or is it appreciated? I'll be the first to admit, yes, it did make them easier to manage, but tied up space in the ER longer and usually made them end up being admitted overnight for observation. I'm just curious if anyone else questioned that judgement call. Doing ground CCT transport in a rural area now, it's used alot for transports due to 2 hours plus sometimes to trauma center with no ability to fly 'em and I'm not going to manage a difficult patient for 2 hours by myself, but just for convenience in the ER? I'm not seeing much of a need for this and wondered if it was prevelant in other areas or just in that particular ER. Thanks !:banghead:

Specializes in Trauma/E.R./ ICU.

I have worked in a Level 1 trauma center for the last 10 years and have never seen a patient intubated for convenience. I have given a lot of medications to try and curtail dangerous behavior, however.

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Specializes in ER, PCU, ICU.

Had one two days ago. 18yo male with a 2 week old driver's license who wrapped his car around a tree with his unbelted mother in the passenger seat. Mom was a traumatic code on scene following her ejection, went to another facility with multiple traumas including a complete cord transection at C6, according to a friend of mine who works in that facility's ED. Grim prognosis.

Junior comes to us with a broken nose and probable concussion. Had to CT him from the head on down to rule out the usual stuff, but he was agitated and combative on scene, all the way to the hospital, and in the trauma bay and wouldn't sit still at all so we could get pictures. Our ER docs and neuro guys don't much like haldol or Ativan with potential head cases, so out comes the RSI box. All films were negative.

He was extubated the next morning, moved out that afternoon, and discharged the next day.

Oh yeah, tox screen showed him positive for meth, cannibis, and ETOH.

We've done it a few times for heavy meth users who are withdrawing.

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Specializes in Emergency & Trauma/Adult ICU.
To the OP,..I assure you it's not "convienient" for me to RSI someone. If you're rude, violent and all around nasty,.I prefer to get you medically cleared and out of my ER!!

... Rather than intubate you and add another vented patient to the likely already ensuing chaos in the ER and take up another ICU bed.

I've participated in this 3 times. One was a patient who got out of leather restraints by ripping the skin off both forearms and proceeded to assault a nurse. Another was a restrained patient who already had 10mg of Haldol but was still thrashing enough to "hop" a > 300 lb. stretcher around the room and scare the wits out of the elderly GI bleed patient in the next bed. The 3rd was an intoxicated MVA patient with some focal neuro deficits - very strong suspicion for spinal injury - who would not otherwise have remained immobilized.

Safety, not convenience, determined the course of action.

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Specializes in ED, ICU, PSYCH, PP, CEN.

In the 3.5 years I have been in my ER I have not seen or heard of it being done, either at my base hospital or any of the other ones I agency at.

I believe that it would be a life saver in some cases.

As you can see from the above posts it is not being done for convenience but rather when no other options are left

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Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.

The term "social intubation" sounds rather odd to me. I would expect most trauma centers and busy ERs get enough practice sedating and intubating patients without doing unnecessary ones for fun.

I've not done a lot of trauma, but the examples cited sound reasonable to me- generally for the patient's own safety, but sedating and intubating for staff safety wouldn't bother me, either, in cases where nothing else is working.

I've seen plenty of ICU patients who required intubation for medical reasons paralyzed and sedated. This too was for their safety. I don't see much difference.

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Specializes in EMS, ER, GI, PCU/Telemetry.
... Rather than intubate you and add another vented patient to the likely already ensuing chaos in the ER and take up another ICU bed.

I've participated in this 3 times. One was a patient who got out of leather restraints by ripping the skin off both forearms and proceeded to assault a nurse. Another was a restrained patient who already had 10mg of Haldol but was still thrashing enough to "hop" a > 300 lb. stretcher around the room and scare the wits out of the elderly GI bleed patient in the next bed. The 3rd was an intoxicated MVA patient with some focal neuro deficits - very strong suspicion for spinal injury - who would not otherwise have remained immobilized.

Safety, not convenience, determined the course of action.

absolutely agree.

trying to sedate/restrain a patient on meth is like wrestling with a 500 pound rabid gorilla. patients like that put the entire ER staff, themselves, and the patients around them in serious danger.

i had a patient on meth/etoh in leathers once, who was unable to get out of the leathers but rocked the stretcher so hard that he flipped it over on himself in an almost 180 degrees, even after being heavily medicated. it was rather impressive. sux was our only hope.

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Specializes in Emergency & Trauma/Adult ICU.
absolutely agree.

trying to sedate/restrain a patient on meth is like wrestling with a 500 pound rabid gorilla. patients like that put the entire ER staff, themselves, and the patients around them in serious danger.

i had a patient on meth/etoh in leathers once, who was unable to get out of the leathers but rocked the stretcher so hard that he flipped it over on himself in an almost 180 degrees, even after being heavily medicated. it was rather impressive. sux was our only hope.

These meth stories kinda fascinate me ... meth is rare in my neck of the woods. Drugs of choice in my hospital's hood are the old standbys - heroin & crack.

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These meth stories kinda fascinate me ... meth is rare in my neck of the woods. Drugs of choice in my hospital's hood are the old standbys - heroin & crack.

It is scary, these people are paranoid and aggressive on a good day. Meth is a widespread problem in my neck of the woods. Labs are easy to set up and with production comes gangs, crime, and violence.

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meth is absolutely rampant in my area, especially where I work ground transport now. It's horrible, there are more methadone clinics springing up than who knows what. The other drug of choice is oxycontin. Pain clinics are abundant too. Sometimes it's a rodeo in the back of an ambulance and in the ER. Lol, makes for a good time !

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Specializes in ER, SANE, Home Health, Forensic.

I think that those who do not work ER will probably never truly understand our descriptive word choices until they do... WE know what "HAM" is, a "B-52", vitamin A and H, getting a xanax for the betterment of the nurse (you with those high-anxiety patients who are on the bell every 2 minutes to tell you they belched, farted or heard of someone who had "EXACTLY" the same symptoms but different 10 years ago and how they had a brain tumor, know EXACTLY what I mean...), alcohol enthusiasts, the joy of the spoken foley threat to the "seizing" incarcerated patient and how hearing that will "cure" them like magic, acute lead poisoning (being shot), the patient and his 6 friends that he brought with him (his different personalitites), "two dude sybndrome" when they were just walking down the street minding their own business when these two dudes they didn't know just jumped them for no reason, funny how same thing happens to people who got arrested by the PD "I was just minding my own business man..." yeah right..., and so many others. We see people at their worst and their best, just like any other nursing specialty, however we get hurt, and we get hurt ALOT by them. We have a very twisted sense of humor and if we didn't have that sense we would be very unproductive members of society, probably with significant PTSD. Intubation for the safety of the patient and staff, and in some cases other patients in the department is not fun but sometimes necessary. Wanna see? Come help me in the ER on the Dave Matthews Band concert nights... usually 2 in a row... I used to LOVE Dave...:twocents:

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Specializes in ER/Trauma.
meth is absolutely rampant in my area
Not too much meth here - but way too many drunk/heroin/crack idiots with guns, knives, shanks and other assorted nonsense... and way too much time on their hands. :no:
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I have given ultimatums to MD’s that go something like… “Either you tube him or I let him go!”. This leaves the choice of treatment course in the hands of the physician. If we can’t control the patient and the situation becomes dangerous for the staff, I would rather let a patient run out the front door than get injured. If it is so important to keep the patient for studies in the opinion of the MD, than they get to choose the course of action.

I don’t “want” to tube ANYONE! It is risky and demands far too many nursing resources to go about it willy nilly. Like all things in the ED, if you really need it…. You will get it!...eventually.

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