Things you shouldn't say to the ER doctor when you bring in a patient

[spenac]

No reason for a medic to ever bring a patient in with an improperly placed tube. To many checks and balances that should be in place to help catch a displaced tube as soon as it occurs.

Can't believe the idiots statement to you doc. Sounds like a confession if incompetence on his/her part. I suggest you contact his/her service and suggest a major airway refresher course.

[ERDoc]

Needless to say, the county medical director is a partner in my group and a good friend. It has been sent for review.

[spenac]

Please just don't allow the knee jerk reaction to remove intubation because of this one medics failure.

[paramedicmike]

Wow. Did he really say that?

Just... wow.

To be a fly on the wall in that meeting. And so many questions.

Is this guy normally that incompetent? Is the department? Was he just having a bad day? Or is this a recurrent problem with him?

[ERDoc]

I wish I had the answers to those questions. We a fairly large city with a huge cachement area so we get lots of providers I don't recognize. I normally don't complain about things that the field crews do. I was on the other side for almost 10 years so I know what goes on but this one felt like it needed to be referred.

[MikeEMT]

So, after a less than stellar performance by a crew the other day I was reflecting on what happened and wanted to share (as much as HIPAA allows) to help others not make the same mistakes. Feel free to make this go both ways as it can be educational for EMS/RNs/MDs/DOs. The purpose is NOT to bash but to learn from others mistakes. Think of it as an unofficial M&M conference.

Paramedic "I'm not sure if the tube is in right."

60s y/o male who coded in front of family. FD first responders did CPR for a minute and got a pulse back. Upon EMS arrival, pt was still unconscious and they were able to drop a tube. 15 minutes out from the hospital the pt goes into arrest again. Asystole upon arrival at the ER. We hear a whooshing sound when we are bagging. At this point the paramedic makes the above comment. Take a look and the balloon is sitting in the back of the throat. Pt pronounced shortly after arrival.

Take home point: If you are not sure the tube is good, make it good or get it out. NEVER have a questionable tube.

Probably a stupid question but could improper tube placement cause the asystole or was that caused by other underlying problems? Obviously it could impact respirations.

This applies to more than just tubes. If your going to do anything - do it properly and don't half-ass it.

[paramedicmike]

Yes. An improperly placed tube could contribute directly (or indirectly) to this patient going into cardiac arrest. Whether that is what happened here is up for ERDoc to expand upon.

[ERDoc]

I can't say for sure but my feeling is it did affect the short term outsome. The guy had stage 4 cancer (don't remember the primary). The pt had ROSC and hypoxia would obviously work against that.

[Curiosity]

I wouldn't be able to sleep at night even with the suspicion that one of my interventions with so many failsafes may have killed a patient. We're human, we makes mistakes and I understand that, but this isn't just a mistake, it's complete ignorance to the basic standards of intubation. And to admit that you think you effed up without trying everything in your power to correct the mistake is unbelievable.

[ambodriver]

If you are questioning the tube, and you cannot confirm it just pull it out. What's wrong with bagging? So many medics have this ego about ET tubes its pretty sick.