I wish it was always as easy as taking a look a putting the tube in.
It seems the majority of codes I've been to on the wards involve:
1. No one seems to know any medical information about the patient except "they were found unresponsive".
If they're dead, you're not going to push any drugs anyway, so who cares about medical information? Only thing I may ask during a real code if they are a surgical patient is if they are a known difficult intubation. We have many faults in my hospital, but if a patient was a difficult intubation, everyone taking care of that patient knows it.
2. There are usually 20 people in the room.
3. The patient is typically in the worst position imaginable for airway management. Some of the hospital beds don't even allow you to reach the patient's head easily.
This is a good excuse to lose weight so you can sneek into tight spots. Also, sometimes you just have to force your way through the crowd to get to the head. Heck, once I intubated standing at the side of the bed because I didn't want to stand in the mess at the head of the bed. But that patient was skinny and the room wasn't crowded yet. I've even intubated some patients (for urgent intubations -- not codes) in the sitting position because they couldn't lie flat I've even done it when the patient was on the floor after choking on a piece of chicken in the Psych dining room. You just have to be flexible but willing to take charge when necessary.
4. There is usually no pulse ox, no suction, no laryngoscope, no ETTs.
You don't have an intubation box with laryngoscopes and ETTs on your code cart? If you don't, then do something about it. Your hospital probably has a code committee -- make them aware of the issue. This way you don't have to drag a whole box around. I carry a backup laryngoscope in my pocket, but I'm been burned before with dead batteries.
As far as the suction goes, that's a major problem at our institution also. I'm sure the two of us are not the only ones either. This is hard to change.
5. The oropharynx always seems to be bloody.
6. With my luck, all these patients have huge tongues.
7. The code team is always reluctant to stop chest compressions so I can take a look.
All of this coupled with the stress of a dying patient makes these intubations much more difficult than those in the OR.
Can't help you much with 5 and 6. As far as 7, usually when I walk in the room I hear someone say "Thank goodness, anesthesia is here." Either way, I announce my presence and once I get to the head, I tell the person doing compressions to keep going until I tell them to stop. Usually I don't need to have them stop, but occasionally it's necessary. You just have to be speak up if they don't stop when you ask them to. I'm 5'4" and 135 lb, and mostly a soft-spoken person. However, I will speak up in these situations if it seems I'm not being heard. If I speak up loudly and forcefully, they'll listen to me. This is because a) I make it clear that I'm calm and in charge the moment I walk in the room, and b) the person doing the compressions is usually just a scared intern or medical student who needs instructions.
As for your last paragraph, I'll say what I told my students when I used to teach CPR: they're dead already. You can't make them any worse. You can only hopefully make them better.
Additionally even if it's a non-cardiac arrest situation, I'm sure you've probably had your share of stressful intubations in the OR. If you haven't, then you will. Being airway experts and being able to perform under pressure is a large part of what defines our specialty.
