Video Laryngoscopy 100% of the time… every time.

[coffeebythelake]

I am certainly not well versed in their academic rankings. Registrar, then consultant? But regardless, at some point there were four anesthesiologists in the room….. kind of scary, that we become so focus on one thing and forgot the basics. Also they multiple people checked breath sounds.

Yes if it was a VL then everyone can actually “see.”

Hearing breath sounds is not a good confirmatory test for tracheal intubation

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[chessknt]

Hearing breath sounds is not a good confirmatory test for tracheal intubation

Especially when there is an audible air leak… wtf was going on in that case so horrible.

 

[coffeebythelake]

Yes if it was a VL then everyone can actually “see.”

I had a case before where VL was used by CRNA / resident (don't remember exactly) and it looked like tube was in, but there was just one brief period where the image wasn't quite perfect, and it still ended up goosed in esophagus. Fortunately it was recognized within 1 minute and replaced appropriately. Bottom line, always have an index of suspicion. There is no such thing as never.

 

[jwk]

With VL everyone in the room knows where the tube went.

Not so with a McGrath - maybe a GlideScope.

 

[MirrorTodd]

Not so with a McGrath - maybe a GlideScope.

Even with a glidescope or cmac on the overhead screen, nobodies paying attention unless they're already an anesthesia provider or they were told to pay attention. I suppose maaayyyybe the ENT's actually watch the intubation on the overhead.

 

[dannyboy1]

I had a case before where VL was used by CRNA / resident (don't remember exactly) and it looked like tube was in, but there was just one brief period where the image wasn't quite perfect, and it still ended up goosed in esophagus. Fortunately it was recognized within 1 minute and replaced appropriately. Bottom line, always have an index of suspicion. There is no such thing as never.

Agreed. No ET CO2 and saturations dropping, tube is coming out. Don’t care how well it looked on the screen. Anoxic injury due to a tube in the esophagus should be a never event.

 

[Mman]

Agreed. No ET CO2 and saturations dropping, tube is coming out. Don’t care how well it looked on the screen. Anoxic injury due to a tube in the esophagus should be a never event.

if you see it between the cords, no ETCO2 and sats dropping is from bronchospasm or cardiac arrest

 

[coffeebythelake]

if you see it between the cords, no ETCO2 and sats dropping is from bronchospasm or cardiac arrest

If it is ridiculously hard to bag then I agree severe bronchospasm. Otherwise should still entertain the possibility that "seeing it go through the cords" is an illusion especially if a trainee or less experienced operator does it

 

[vector2]

I'm kinda disturbed by the frequency at which esophageal intubation is mistaken for bronchospasm. We had one recently at our shop as well (2 docs DL'ed and thought tube was through cords) which was caught before any pt harm occurred.

The take home message for residents is that if you intubate and there is *any* irregularity in the ETCO2, number 1, 2, and 3 on the Ddx is goose / tube has popped out and is supraglottic. And someone should be putting a VL in the mouth immediately so that everyone can see the screen and agree the tube is through cords.

 

[Mman]

If it is ridiculously hard to bag then I agree severe bronchospasm. Otherwise should still entertain the possibility that "seeing it go through the cords" is an illusion especially if a trainee or less experienced operator does it

I agree I don't trust other people. But if I am personally 100% sure it is through the cords, I have seen more times than I can count of enough Bronchospasm to not have any CO2 on the screen for several squeezes of the bag.