Spending my time
10+ Year Member
- Oct 17, 2007
- Attending Physician
Worst induction ever with a possible neck hematoma. World class stupid. This was the classic case of a ketamine or ketadex induction, to buy time while navigating an unknown anatomy. This is the patient one does not paralyze until the last minute, when one sees the glottis and is ready to intubate. They were very lucky they got the tube in.What are your thoughts about how they went about this intubation? With impending airway comprise stated with AMS and progressive swelling, no time for an awake fiber optic. I wonder if they had a fiber optic in hand at these facilities. Induction of etomidate/sux/midaz seems reasonable. I’m kinda surprised paramedic got it after 4th try with glidescope over the EM doc but who knows. I wonder what they tried to sedate the patient with as it doesn’t state in the article. Do they even have stuff like propofol drips, fentanyl drips etc? Should they even have privy to that type of sedation? This is not in their usual scope of care I believe? This doesn’t look good for freestanding EDs for true emergencies like this.
Also, they should have opened up the stitches first.
The value of a CXR is as a third-party record of an ETT-in-place at a given time.