STAT intubation advice PLEASE!!!!!!!!!!

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What is your MOST IMPORTANT advice regarding stat intubations on the floor?

I am just a wannabe, but I have heard residents say STOP which stands for-Suction, Tube,Oxygen, and Prescription. Do not proceed without these.

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I am just a wannabe, but I have heard residents say STOP which stands for-Suction, Tube,Oxygen, and Prescription. Do not proceed without these.

What in the world would Prescription stand for in this case?

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Why none other than DRUGS.

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Nice sarcastic tone there, but perhaps you should look around and see that you are in the CRNA forum.

WE decide what drugs to give and not give and WE adminster them without question from residents, staff RNs or anybody else.

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Specializes in ER, Peds, Charge RN.

I'm thinking the poster meant for you CRNA's to give the nurses sedation orders... after all, you have to leave the floor sometime. I highly doubt anyone was suggesting that the CRNA must have an "order" to intubate, paralyze, or sedate.

Wow.

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Wow.

Thanks for your input.

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RN 29306,

I am sorry by no means whatsoever was I being sarcastic. STOP was just a mnemonic I heard the resident say when teaching a new resident to intubate. I had never heard of it and I thought I would share it. I have the highest respect and regard for CRNA's, and I am acutely aware that I am in a CRNA forum and do not have much to add. I am very aware that CRNA's do not need orders for drugs and do not take orders from residents or nurses.I know that CRNA's know their drugs much better than most residents and actually give what is necessary, unlike what I have seen from residents. If I had my pick I would choose a CRNA over a resident anyday to intubate me or my loved ones. Again I am sorry if you took it that I was being sarcastic, this was absolutely not my intention.

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EDVALERIERN,

Thank you for your defense, that is what I meant.

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rn29306 has it right.

I'm an RRT in ICU, and in the smaller hospital I work at per diem, there is no night anesthesia or unit attending coverage - RTs intubate and wait for the pulmonary doc to come in. Sometimes if we're lucky if we have an ER doc some nights that will come up and help out. But they ususally dont respond right away.

The first time I had to run to a floor to intubate someone by myself- I thought that someone was going to have to do me next because I was about to die from nervousness.

But remember- unless the airway is compromised or your pt has vomited and aspirated, just bag valve mask ventilate while you everyone gets everything together for you. I mean you dont want to take a year and a day, but dont go crazy throwing everything around, droppin mac blades on the floor and poking yourself in the eye with the bougie. Get someone to get respiratory up there pronto so they can bring a vent and assist you. If you're calm, the people around you will be calmer. So many times I see young practicioners fly into the room as if acting like something you see on "ER" on tv. Being all stressed and dramatic doesnt make you a better practicioner. Running a smoothe code does.

We dont give sux on the floor unless we really need it, maybe something like a hit of roxy sometimes if someone's totally clenched down. Usually versed does the trick. If Respiratory is there have them be your right hand person to stand by with Yankhauer and regular suction (like rn29306 said, crank that bad boy up!) and get your ETT tube and CO2 detector all nice and ready, and to provide cricoid if you need it. Have a nurse take over bagging the pt from the other side of the bed, your left. There are lots of people at a code usually- put them to work!

Make sure everyone bags properly and has the pts head in the right position! I have seen so many people panic bc the pt is desatting, meanwhile they arent giving effective breaths, or maintaining a proper seal.

Familiarize yourself with trachs. Inner canula, outer cannula, different cuffs (bivonas, shileys, portex blah blah blah) A lot of old people's trachs plug, they rip them out, or they have a problem with the cuff and that leads to a lot of stat intubations.

And watch out for dentures man... the first time I intubated, the guys teeth popped out and almost gave me a heart attack!

Nurse: "oh... ummm ...he has dentures."

It will be OK... just relax. Assess the situation, bag the pt, sedate if necessary, have everyone prepare your stuff, and give it a go. Monitor sat, rhythm and vitals. And if you dont get it after your third try, don't let pride keep you from asking your RT to "just have a look" :)

Good luck!

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Specializes in Anesthesia.

As to the original question, there have been excellent suggestions here, and though I sometimes joke that all we in anesthesia require to intubate is a tongue blade and a flashlight, I did hear a new one recently, working with Special Forces medics: one of their instructors still carries with him a tool he improvised under fire in Vietnam, a TENT STAKE he had bent at a right angle to serve as an laryngoscope.

!

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Specializes in Adult and Pediatric Vascular Access, Paramedic.

remember to appropriatly ventilate the patient prior to intubation attempts and inbetween (if need be), and of course after.

Swtooth

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I'm thinking the poster meant for you CRNA's to give the nurses sedation orders... after all, you have to leave the floor sometime.

That would work if CRNA's could write sedation orders. In our unit we have the autonomy to start precedex or propofol, though I usually get sedation orders when I call the surgeon for intubation orders. The nice CRNAs will bump with proppfol before they leave :>

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