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    Default Floor intubation previous Trach

    Went to a floor intubation call last night. Patient was obtunded on BiPAP. Had been NPO all day, not much relevant medical history, NKA. HR 120s, BP 118/64, sat ~96%. Went to the head of bed and noticed a previous trach site on his neck.

    Anyways, I went to intubate with MAC 4 after 80 of propofol. Could see arytenoids. Asked for a bougie and got it in. Threaded an 8 mm tube over it. Went to twist it in and couldn't pass it past 17 cm @ lip. A lot of manipulation and eventually he starts to desat. So we pull the bougie and attempt to ventilate through the tube. Good bilat breath sounds, positive color change on EZ cap. Seemed shallow, but I guess we got it?

    Fast forward 20 minutes, receive a call that the tube is in the patients "throat" per the RT per X-ray. So we go back. Tube is out when we get back (which I wasn't happy about since we could ventilate just fine through it and had planned on using a tube exchanger. RT said he "mouthed it out". Whatever).

    So intubation attempt #2. This time, Propofol, Succs, Glidescope, bougie. I passed the bougie via glidescope (not before the glidescope died however! Note: when using the floor's glidescope, it may have been sitting not plugged in for days.) Anyways, attempted to thread a 7.5 over bougie with no luck. We could get the tip and about 1/3 of the balloon in but no further. He had a very strange, narrow looking glottis anyways. Proceded to attempt a 7.0, 6.5, and finally a 6.0 which passed. We all celebrated.

    Pretty interesting floor intubation though. Take home lessons: Previous trach site may mean very narrow glottis! Prepare accordingly. Also, plug in glidescope.
    Last edited by Mully; 07-10-2015 at 09:19 AM.

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