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

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

Specializes in CRNA, ICU,ER,Cathlab, PACU.

get there before anyone else has a chance to bang up the patients airway...document any trauma caused by flailing attempts by other providers...

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Keep in mind that you are definately on your own on the floor. While in the OR, circulators may be able to hand you an LMA/bougie/Miller vs Mac blade/etc, but don't expect the floor staff to recognize these terms nor the fact that you are managing a difficult airway.

My "check list"

Suction ready

Free flowing IV with injection ports (not pump tubing running through a

machine at KVO)

Drugs (induction, pressors, NMB's)

Laryngoscope/blades handy (i.e. where I can get to them and not

need asssistance)

One or two ETT's (I preferentially intubate with an 8.5 in order to facilitate

easy bronchoscopy in the ICU)

LMA and Bougie readily available

In addition, floor patients seem to be universally dehydrated -- I lube my blades.

Mick

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the first thing i do is ask what's going on as i visualize the patient, i get a brief synopsis (allergies, events leading to) of the situation as i'm looking to see if there is already a blade, tube, and working suction at the head of the bead. I then visualize the effect of whoever is bagging the patient and see if the belly is distended and what the sat is. i take my place at the head of the bed and always ask for on ORAL AIRWAY. i usually place it and try to bag the patient to 100 with their effort or not if there isn't any. if needed ill have them give a little versed and/or etomidate before intubating. if someone automatically gives cric pressure i ask them to let up because they're usually placing too much.

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Specializes in Anesthesia.

Make sure you having working SUCTION!!! There is nothing worse can going in with your blade to find that you can't visualize anything because you have a mouth full of secretions (or worse, vomit) and the suction in the room is not working. Obviously this has happened to me before......learn from your mistakes....haha....

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Specializes in SICU.

RRT2CRNA, you certainly have a head up on the rest of us RN working in the ICU and trying to get into CRNA school....what is your timeline to get in?

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I wish I was further ahead than I am! but I will be finishing my RN and going straight into CTICU by summer next year...

Then we'll see how that goes, but I am hoping/planning to apply to schools about 6 months into that gig if I feel I am ready... I love respiratory and I'm sure I'll have fun as a nurse too... but I just turned 31 and the biological clock is ticking very loudly lately. I want to be done with the whole thing by the time I turn 35... latest 36. Very intimidating and stressful as a woman trying to get all this done... I always feel like Im under the gun!

RRT2RN2CRNA

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Specializes in SICU.

good to hear, i wish you the best and I will see you at the finish line. ;)

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RN29306 or whatever the numbers are....

Milo.. I think that you are getting some very sound advice here with tips and tricks to intubate a floor patient. Also, thanks to shari for the STOP!..

I just wanted to say that rarely should you ever need to use a paralytic on a floor/emergency intubation.. RARELY. Also, if you are insisting on using propofol then you better do the dip and dope combo when you get to the unit. Technically,you just need some midazolam and etomidate if anything at all.

As for bumping the resident out of the way, make sure they aren't an anesthesiology resident... they definitely wouldn't appreciate it, since they run all the codes and intubate endlessly the intern year.. also if you are a crna most likely you wont want to give them a bad impression of you since you will be working under an MD in the future,

... because people like RN29'er seem to be the ones that are giving you guys a bad name..

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Specializes in ICU/Flight.
RN29306 or whatever the numbers are....

Milo.. I think that you are getting some very sound advice here with tips and tricks to intubate a floor patient. Also, thanks to shari for the STOP!..

I just wanted to say that rarely should you ever need to use a paralytic on a floor/emergency intubation.. RARELY. Also, if you are insisting on using propofol then you better do the dip and dope combo when you get to the unit. Technically,you just need some midazolam and etomidate if anything at all.

As for bumping the resident out of the way, make sure they aren't an anesthesiology resident... they definitely wouldn't appreciate it, since they run all the codes and intubate endlessly the intern year.. also if you are a crna most likely you wont want to give them a bad impression of you since you will be working under an MD in the future,

... because people like RN29'er seem to be the ones that are giving you guys a bad name..

BTW - in regards to paralytics not being needed for Emergency Intubation, you might want to take a look at Ron Wall's Manual of Emergency Airway Management...

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BTW - in regards to paralytics not being needed for Emergency Intubation, you might want to take a look at Ron Wall's Manual of Emergency Airway Management...

if you read my post.. i said RARELY, never ever did i say never...

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