Recently, we had a patient who following surgery, was extubated and went to the PACU. While there, the patient was reported as having stridor, resulting in reintubation. It took three difficult attempts to reintubate this patient, during which three bottom teeth in the front were broken. We "heard" that someone who "never fails an intubation" was called to assist, and it still took three difficult attempts. On the unit, blood was discovered in the patients ear and later it was discovered that there was a ruptured tympanic membrane. The three teeth were extracted also on the unit. The eardrum is being blamed on the difficult intubation. The patient has a fairly recent history of a lengthy hospitalization with 25 days on the vent followed by three months of being trached. The patient also has a lengthy medical and surgical history including "difficulty with intubations", extubations, weaning, a past CABG, vascular issues, cardiac arrest, ARDS, DM, and HTN.

Now the patient is of course mechanically ventilated and discussion is ongoing as to whether the patient should be trached now, or later. I am interested in other opinions as to what else (if else) could of been done with the patients best interest in mind during the difficult intubation, that might of spared the broken teeth and the ruptured eardrum and the now very traumatized trachea! I also had to post this here because since I am not a SRNA yet, it wont let me post in a more appropriate place.