aggressive bagging

[Gas you down]

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walked into a crna bagging a patient on the floor just before attempting intubation.

BOOM!

?what the hell was that?

oh nothing, just the colostomy bag exploding.

sheets on the bed saved us. a mental note was made....

 

[DreamMachine]

walked into a crna bagging a patient on the floor just before attempting intubation.

BOOM!

?what the hell was that?

oh nothing, just the colostomy bag exploding.

sheets on the bed saved us. a mental note was made....

Another reason to wear eye protection.

 

[MTGas2B]

From bagging? Really? It would take some serious force to get air in the hind gut. I'm suspicious that aggressive BMV could cause this. Gastric and duo sure. Colon or ileum, not buying it.

Side note. When I'm bagging a patient during a code or respiratory embarrassment and they have a g-tube I ask someone to connect it to a foley bag.


On the iPhone

 

[RxBoy]

sheets on the bed saved us. a mental note was made....

On call responded to a trauma code in ER resuc bay. 7 yo F s/p vehicle vs. pedestrian. RT was bagging the patient a liter at a time full force. I yelled at her to stop when I got there but I was to late, pt aspirated some very nasty stuff. Stomach was literally popping out of the rib cage. Immediately suctioned and secured tube. Pt subsequently developed ARDS. 2 weeks later on a vent in ICU she thankfully made a full recovery. RT didn't think she did anything wrong. To this day I am very weary of anyone other than anesthesiologist bagging pts.

 

[BobBarker]

On call responded to a trauma code in ER resuc bay. 7 yo F s/p vehicle vs. pedestrian. RT was bagging the patient a liter at a time full force. I yelled at her to stop when I got there but I was to late, pt aspirated some very nasty stuff. Stomach was literally popping out of the rib cage. Immediately suctioned and secured tube. Pt subsequently developed ARDS. 2 weeks later on a vent in ICU she thankfully made a full recovery. RT didn't think she did anything wrong. To this day I am very weary of anyone other than anesthesiologist bagging pts.

This is why the dumbing down of ACLS hurts patients. Never, never have I seen effective BMV in progress when I have been summoned to intervene.

 

[Gas you down]

From bagging? Really? It would take some serious force to get air in the hind gut. I'm suspicious that aggressive BMV could cause this. Gastric and duo sure. Colon or ileum, not buying it.

Side note. When I'm bagging a patient during a code or respiratory embarrassment and they have a g-tube I ask someone to connect it to a foley bag.


On the iPhone

not colon, was duodenal ostomy. but really, when called to a code, i'm not gonna ask what the ostomy is hooked up to, i'm just gonna remember an exploding bag of feces and act accordingly.

 

[Lightwand]

This is why the dumbing down of ACLS hurts patients. Never, never have I seen effective BMV in progress when I have been summoned to intervene.

I was called to an airway in the ICU once. When I showed up there were 2 RTs "bagging" the patient. Sats were 34% (obviously that's not going to be accurate, but the dude was blue). They told me he was impossible to ventilate. I took over and sats were 97% within a minute. Amazing what happens when you lift the mandible, rather than smashing the mask onto the face.
It's a scary, scary world out there.

 

[dhb]

It's a scary, scary world out there.

And still people survive 😕

 

[cincincyreds]

I was called to an airway in the ICU once. When I showed up there were 2 RTs "bagging" the patient. Sats were 34% (obviously that's not going to be accurate, but the dude was blue). They told me he was impossible to ventilate. I took over and sats were 97% within a minute. Amazing what happens when you lift the mandible, rather than smashing the mask onto the face.
It's a scary, scary world out there.

Pretty soon there will be midlevels doing most of the jobs of doctors to save money. There will be some phd nursing of critical care/ anesthesia / surgery degree that is a one week online course for 2 hours a day.

 

[JSBMD]

I realize this was a serious post, but I laughed so hard when I read this that my eyes watered! In 15 years of PP, never even heard of this one before.

Definitely agree that I've NEVER seen effective bagging at a scene of RN/RT/CRNA/etc "resuscitation".

 

[urge]

walked into a crna bagging a patient on the floor just before attempting intubation.

BOOM!

?what the hell was that?

oh nothing, just the colostomy bag exploding.

sheets on the bed saved us. a mental note was made....

 

[Matty44]

Called to a trauma in the ED, 11y F involved in an MVA. RT bagging the pt probably 35-40 bpm, good sized TV. Pt was already intubated at this point so there is good gas exchange going on. I suggested she ease up a bit. She shoots me a dirty look and says she's fine. About 30 seconds later, one of the peds anesthesia fellows joins the party. He comments to me that he thinks she's being a little aggressive...she won't listen to him either. ED only stocks the colorimetric CO2 detectors, but they do have ETCO2 monitoring capabilities on their monitors. We call for some tubing to hook it up, and meanwhile, the pt seizes. ETCO2 gets hooked up and reads 9. RT and ER resident both comment on how these things are never accurate. Pt to CT, RT still bagging, another seizure upon transport to the scanner. Hook up to ETCO2 on anesthesia machine in CT, ETCO2 8 now. ICU attending now present, tells the RT to slow down, she finally does and CO2 slowly creeps up to the mid 30s.

RT mutters something about "inaccurate crap..."

 

[IlDestriero]

In the future if someone is doing something wrong, clearly wrong, and potentially harmful, if they don't heed your suggestion for appropriate action then you need to relieve them. As in, GTFO of my way *****, go review respiratory physiology and then come back and we'll talk. You're the physician, they're the technician. Try to be very concrete, like "hey RT person, ventilate at an appropriate tidal volume at a rate of 15, that's one breath every 4 seconds, with a 1 to 2 I to E time." That's an order they are obligated to follow. Don't let people F up when you know they're Fing up. And if they give you BS about accuracy, etc, correct that as well. This person will continue to be a pathetic excuse of an RT because she still thinks she was right, and she obviously was not.

Cheers!

 

[itwasalladream]

Especially pts with COPD...we had an ICU pt nearly code not on induction for intubation, but a few minutes later while waiting for the vent to be set up and connected...meanwhile RT bagging at large TV 30/min in a severe COPD'er.

Another time - RT bagging ETT 30/min at a code, after a while they finally call the code. Everyone leaves the room, someone disconnects the ambu bag from ETT with loud rush of air, noticeable sudden chest drop. My co-resident, just out of curiosity checks a pulse as everyone is leaving/cleaning up. Pt suddenly had a pulse. Transported to ICU, with poor outcome.

IlD's point is well-taken. As very green resident, sometimes it's tough to call out people with more seniority but it's gotta be done if you know they're screwing up. Lesson learned.

 

[RT2MD]

walked into a crna bagging a patient on the floor just before attempting intubation.

BOOM!

?what the hell was that?

oh nothing, just the colostomy bag exploding.

sheets on the bed saved us. a mental note was made....

😆😆

In the future if someone is doing something wrong, clearly wrong, and potentially harmful, if they don't heed your suggestion for appropriate action then you need to relieve them. As in, GTFO of my way *****, go review respiratory physiology and then come back and we'll talk. You're the physician, they're the technician. Try to be very concrete, like "hey RT person, ventilate at an appropriate tidal volume at a rate of 15, that's one breath every 4 seconds, with a 1 to 2 I to E time." That's an order they are obligated to follow. Don't let people F up when you know they're Fing up. And if they give you BS about accuracy, etc, correct that as well. This person will continue to be a pathetic excuse of an RT because she still thinks she was right, and she obviously was not.

Cheers!

As a former RT, I have to agree here... I have seen some of my peers (and I know I've been guilty as well) do some scary stuff, but would fix it when called out on it by RT/RN/MD/DO/Housekeeping. 😎

I think that most should respond well to some education, if they don't... well... then somebody needs to deal with them before they kill somebody. It has been interesting how many things I "knew" as an RT were wrong. I have had to unlearn some bad habits for sure... and I'm sure that trend will continue through 3rd and 4th year...

 

[Matty44]

In the future if someone is doing something wrong, clearly wrong, and potentially harmful, if they don't heed your suggestion for appropriate action then you need to relieve them. As in, GTFO of my way *****, go review respiratory physiology and then come back and we'll talk. You're the physician, they're the technician. Try to be very concrete, like "hey RT person, ventilate at an appropriate tidal volume at a rate of 15, that's one breath every 4 seconds, with a 1 to 2 I to E time." That's an order they are obligated to follow. Don't let people F up when you know they're Fing up. And if they give you BS about accuracy, etc, correct that as well. This person will continue to be a pathetic excuse of an RT because she still thinks she was right, and she obviously was not.

Cheers!

Yeah, I learned my lesson and will definitely be more assertive in the future.

 

[europeman]

Surgery chief resident here:

I'm no airway expert, but being the one who is stuck dealing with the sequelae of aspiration and poor ventilation has made me very aware of this problem.

I have never seen a code on the floor where airway was being managed appropriately before anesthesia. It's very frustrating.

Our ER is actually probably the best.... A lot of the ER guys actually do a nice two handed seal and let the vent do the controlled, appropriately timed/volume ventilations. This is nice because no matter how much adrenaline is pumping, the machine doesn't distort things. Our ER is good that way though because all the rooms where sick patients go have vents ready to go.

I have to say though if I am there because it's my patient or what have you and RT it ICU fellow medicine code person is bagging inappropriately, I politely but firmly make sure they change.

 

[RxBoy]

Surgery chief resident here:

I'm no airway expert, but being the one who is stuck dealing with the sequelae of aspiration and poor ventilation has made me very aware of this problem.

I have to say though if I am there because it's my patient or what have you and RT it ICU fellow medicine code person is bagging inappropriately, I politely but firmly make sure they change.

The irony here is I would gladly correct another resident/attending if something was improperly being done. We all have mutual respect for each other and understand the vast knowledge we possess from our respected specialties.

Classic example: last week about to intubate patient and surgery resident tells me: "hey just a heads up I would probably RSI this patient, they have been NPO for 24 hours but they been going through opiates like candy and vomited quite a bit the day prior". I respectfully agreed, never argued, never once thought how dare he questioned my airway technique. RSI'ed the patient and sure enough after OG suction got a good 100 cc of junk.

When I correct another resident on improper technique specific to my specialty, they readily agree because of the mutual respect. As physicians we have humility because we know there are somethings we simply don't know. Its these select egotistical nurse/ RT/midlevel a*holes who don't know what they don't know. And because they don't know, they think they're right and patients suffer. Trying to correct them almost always ends in some type of useless argument or getting written up. I am convinced, most of them actually enjoy it.

 

[RT2MD]

The irony here is I would gladly correct another resident/attending if something was improperly being done. We all have mutual respect for each other and understand the vast knowledge we possess from our respected specialties.

Classic example: last week about to intubate patient and surgery resident tells me: "hey just a heads up I would probably RSI this patient, they have been NPO for 24 hours but they been going through opiates like candy and vomited quite a bit the day prior". I respectfully agreed, never argued, never once thought how dare he questioned my airway technique. RSI'ed the patient and sure enough after OG suction got a good 100 cc of junk.

When I correct another resident on improper technique specific to my specialty, they readily agree because of the mutual respect. As physicians we have humility because we know there are somethings we simply don't know. Its these select egotistical nurse/ RT/midlevel a*holes who don't know what they don't know. And because they don't know, they think they're right and patients suffer. Trying to correct them almost always ends in some type of useless argument or getting written up. I am convinced, most of them actually enjoy it.

I would bet many of these types would also think that they were right... my observation from being on the otherside.