Oesophageal Intubation: Still occurs in this day & age.

[chbare]

http://m.jems.com/article/news/alleged-paramedic-mistakes-cost-chicago2

No mention of Carbon dioxide monitoring.

[Paramagic]

That is staggering. Regardless of whatever other clusterf**ks went on, no waveform capnography = no intubation. End of story.

[DwayneEMTP]

Each of these errors would have been avoided had they just followed the tenet of patient advocacy first...even if it means getting jammed up later.

What kind of a douche stays on scene, for any reason, with a traumatized, intubated child in the ambulance? I don't care if the President gave that order...the baby is going to the smart people at the hospital. I can't even imagine the level of care delivered by a medic that would have even a moments quandary over that.

Dwayne

[paramedicmike]

Wow.

Just. Wow.

[BillKaneEMT]

Ok. First of all, that attorney is absolutely right. (Never thought I'd say that) What a stupid rule. If our protocols put property damage at a higher priority than patient safety then everyone involved in creating that rule, from the medical director on down, needs to lose their damn job.

Secondly, I guess I can't speak for paramedics, the only thing we're trained for is a combitube (non-visualized airway device) and once it's in place if you don't hear breath sounds in the lungs OR you hear air in the abdomen you immediately swap the bag to the other tube and listen again. Now, before everyone gets mad, I admit I've never done this to a live patient on a rig, and obviously paramedics have had a helluva lot more training than me. I simply can't picture this happening around here. I did several ride-along days with the ALS unit of our fire department and between calls I heard about a ton of crazy calls and screw ups they had run into in the last 25 years but this is terrible. On the other hand, if those guys ever did something like that they probably wouldn't tell me.

Just to make sure I'm not missing something here, a little girl was having an asthma attack. The paramedics intubated her through the esophagus instead of the trachea, then didn't check to verify the placement. The patient's condition did NOT improve, the rig had a fender bender and after confirming the other vehicle's occupants were ok the paramedics chose to sit on scene with their steadily worsening patient and continue bagging into her stomach. ffs.

[Yarbo]

It's their emergency... not... yours.... they're Fubar now...

[chbare]

To add additional information: It appears this took place ten years ago, so routine Carbon Dioxide monitoring may not have been as prevalent. The protocol they had about doing a look on intubated patients seems to support my suspicion; however, It appears there were numerous errors here.

[P_Instructor]

To add additional information: It appears this took place ten years ago, so routine Carbon Dioxide monitoring may not have been as prevalent.

Good point, however not condoning the actions that took place, there was lack of responsibility in many other facits of the call. They probably did have an adequate tube initially, but it could have dislodged when the accident occurred (speculation), the attending medic didn't recheck it after the accident because he's pissed about the crash and 'his' ass. Stupid rule to stay on scene if other driver is OK. I wonder how long it took the second ambulance to arrive? Then the secondary ambulance, whether it was the same attendant or a second, should have reconfirmed tube placement prior too and after the move to second rig and transport. Easiest check are breath sounds, equal chest rise, and perfusion of the patient back in 'those' days. Ahhh, the colormetric device was available back then.

Either way, I'm suprised that it is only 1.75 mil.

[Doczilla]

I was once told regarding malpractice, kill them, don't maim them. Malpractice judgments are higher when the patient survives and is crippled than when they die outright.

The move for ETCO2 monitoring/detection became standard in EMS only a few years ago, so while the colormetric devices were available, they weren't necessarily in widespread use. The question is, was the tube dislodged, or misplaced in the first place? That's why waveform capnography is so helpful in cases like this; it's written proof of proper placement, and warns you of dislodgement or other problems.

There are other issues here which are not clear. Remember that the lawyer will paint everything in the worst light possible. It helps their case to paint the responders as complete idiots to generate negative sentiment against those who don't know them (as this article has done here). Remember that juries generally LIKE EMS providers and firefighters. In order to overcome their generally positive regard, the lawyer has to make them look like complete buffoons. They also (in many states, not sure if IL is one of them) have to overcome a standard of "willful or wanton neglect".

It is entirely possible that this patient was already very unstable. An asthmatic who has to be intubated has a very high likelihood of death. Intubation is not particularly helpful unless you can paralyze them, extend the i:e ratio, and maybe give Heliox. The medics were already dealing with a critically ill patient for whom they had few remedies beyond IM epi.

Never hang anyone out to dry just based on what's said by the plaintiff's attorney.

'zilla

[Kiwiology]

Intubating an asthmatic patient might actually increase their risk of death, the problems of hyperdynamic inflation are not well understood by American Paramedics it seems, we've had enough problems making it understood here.

If you intubate an asthmatic patient you will improve ventilation but you probably won't increase oxygenation much, not sure but my money is on not really. And since when is oxygenation the problem in asthma? It's not, the problem is ventilation and the exchange of CO₂?

... and even if you do decide to intubate them, ETCO₂ is going to be extremely high and might not actually be of much use?

Even at Intensive Care Paramedic level I would be extremely hesitant to intubate an asthmatic patient

Oh and news flash, you can give adrenaline as an IV infusion for asthma now too, it's good stuff, you bloke might want to try it some time

Edited February 25, 2012 by kiwimedic