First Responders For Codes/Intubations

[Yangkower]

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Just curious how other hospitals/programs handle codes and emergent intubations. Where I went to medical school, interns responded to codes and were intially responsible for airway. When/If they failed, anesthesia took over. Where I train now, anesthesia residents (CA2,CA3) do all intubations in the hospital with an anesthesia attending as back up. Some ER attendings will do the "easy" ones in the ED. This is great for anesthesia residents (we may do 4-5 emergent intubations during a call). Some residents and fellows from other specialties seem a little annoyed by this setup, of course they are always welcome to come to the OR to practice.

I've heard that respiratory therapist do intubations at some hospitals which seems to make some sense if no MD in house.

 

[PMPMD]

Just curious how other hospitals/programs handle codes and emergent intubations. Where I went to medical school, interns responded to codes and were intially responsible for airway. When/If they failed, anesthesia took over. Where I train now, anesthesia residents (CA2,CA3) do all intubations in the hospital with an anesthesia attending as back up. Some ER attendings will do the "easy" ones in the ED. This is great for anesthesia residents (we may do 4-5 emergent intubations during a call). Some residents and fellows from other specialties seem a little annoyed by this setup, of course they are always welcome to come to the OR to practice.

I've heard that respiratory therapist do intubations at some hospitals which seems to make some sense if no MD in house.

Where I did residency, the PACU resident (usually CA-2 or 3) would hold the pager/respond to codes during the weekdays. Nights and weekends it was the OR anesthesia resident on call (CA-1/2). It's similar where I'm doing fellowship except SICU fellows also respond during weekdays.

It would be nice if the 25 people who get to the code before me would pull the bed back from the wall - you know, like we do at EVERY code. It was more fun when BLS was "ABC" - I could push past people saying "Airway comes first!" Now, with "CAB" it's just not the same.

 

[Yangkower]

It's like the first time every time. There must be a correlation between patients who code and the lack of useful information that the people taking care of them possess.

 

[Bostonredsox]

we (internal medicine) are the only residents other than FM at my hospital. We respond to all codes. We run the codes, intubate and put in all the lines. The night team handles all at night outside of the ed obviously which they handle internally. During the day, the CCU team, which is made up of all IM residents, responds to all codes. Depends on what your hospital has for staff. I call anesthesia to let them know I am intubating and if I think it will be a difficult airway I ask them to come back me up and bring their lovely glidescope.

 

[dhb]

we may do 4-5 emergent intubations during a call

Really, are you in a 10.000+ bed hospital? I have a hard time figuring what type of scenarios you could encounter 5 times per shift that would require a floor intubation.
I think i might have tubed a patient ounce on a floor but i'm not even sure...

 

[PMPMD]

Yeah 4-5 per call sounds busy. At our 1,000 bed tertiary center, we averaged 1 or less per call. There were one or two nights we got up to 3-4, but that was atypical.

 

[Yangkower]

Yep a very large hospital. That is in a 24 hour shift. Covering SICI, MICU, CCU, ED, Neuro ICU, PICU, NICU and several hundred step down and regular floor beds.

 

[BobBarker]

We run the codes at the private hospital where we do internship and obviously handle the airway as well. At the university MICU does the floor codes and tubes. We are 24 hour difficult airway backup.

 

[Apollyon]

Yep a very large hospital. That is in a 24 hour shift. Covering SICI, MICU, CCU, ED, Neuro ICU, PICU, NICU and several hundred step down and regular floor beds.

Are you in the US? Together, this picture in total doesn't make sense. I mean, if it is that busy, how is it that the ED is calling you for intubations? You mention the "easy" ones, and that is most of them. So, are you called for difficult tubes, or is the doc (as it sounds like there are not EM residents) standing at the bedside, bagging, waiting 2-5 minutes for you to get there? And the critical care docs, such as in the MICU and PICU & NICU, don't intubate their own patients? Really?

 

[Yangkower]

ED docs (attending or resident) intubate what they consider "easy". They only call anesthesia if they fail or don't want to try which is always with certain attendings. Anesthesia does almost all trauma patients.

The vast majority of fellows in the ICU are not anesthesia and they don't generally intubate except NICU and PICU. Some ambitious fellows will, but it is surprisingly rare.
Don't know why, it's just the culture. If I were a non anesthesia fellow I would see this as a weakness. Like I said on the original post it is good experience for the anesthesia residents.

It sounds from the responses that this system is a little unusual which is why I posed the question to begin with since it was different than the system my medical school used.

Something else that may be unusual is that general surgery instead of ENT is called for emergent surgical airways in most cases.

 

[BobBarker]

How often do emergent surgical airways come up?

 

[Yangkower]

Rare. Personally never seen it. Heard about it twice. In past year.