Taping Endotracheal Tubes

[caregiver222]

Endotracheal intubation has become a common accepted method of airway management. Many jurisdictions permit paramedics to intubated in the field. In a disaster it will be expected that patients so intubated have to be moved. This leads us to differentiate between patients intubated in a hospital by anesthesiologists and those tubed by paramedics. The medics will thoroughly secure the tube with much greater security than then is the hospital norm. In general, the hospital standard is not sufficient to permit transport without undue hazard of extubation. The issue is further complicated by an overlap of responsibility and authority during such transport. There is a rush to move the patient, a fresh-behind-the-ears intern is cobbled up to accompany the patient, and everyone rushes off to see the wizard. Between the hospital and the ambulance or hopa-copter, the board or guerney moves one way, the person bagging moves the other and the endotracheal tube gets pulled out. Worse, there is rarely one person in charge to issue orders. When transporting such a patient one person should be designated in charge of the movement. Unfortunately, this is usually the intern, who is very reluctant to exercise command for a number of psychological reasons.

Assuming this represents a routine movement of a stabilized intubate patient, one individual must be designated to perform bagging or monitor the airway.

Before moving the patient one person must check to see the endotracheal tube is doubly-secure. This means extra circumferential wraps around the patient's head.

Before movement the command is given to the person bagging:

"We are going to move this patient now to _________. Our route will be_____________. We will have to enter one elevator and go down six flights of steps. Is trhe endotracheal tube secured to yourt satisfaction and are you ready to move?"

The person then waits for a verbal affirmative answer:

"Yup. Ready to travel," works for me.

[caregiver222]

That leads us to another point regarding emplacement of endotracheal tubes, especially in the field (i.e. a disaster), but my comment also applies in the hospital.

There are two passageways leading downward from the mouth. One is the trachea (where the tube is suppossed to go), and the other is the esophagus (where it ain't suppossed to go).

Sadly, the number of room temperature patients in that condition because the tube went in the wrong hole are many. A little hidden secret.

"Sorry...your mom's dead...but we did everything we could..."

And I have a Brooklyn Bridge to sell you.

When the tube is emplaced the lung fields are auscultated.

My preferred procedure is for the person performing the eube to first auscultate the right field and verbally state "right O.K."

Then do the same with the left stating "left O.K.".

Here's where I disagree with the current field procedure in some communities.

You shouldn't be ready to "pack and run" until a SECOND paramedic takes his stethascope and CONFIRMS TUBE PLACEMENT. Verbally.

I'd like to make that standard procedure in the ER also.

There should be a "two-person" confirmation rule regarding tube placement.

Sadly there is ego involved. And hubris.

Especially by the "Top Man".

The two=person placement rule saves lives.