Medic26 Posted July 29, 2007 Posted July 29, 2007 I was asking if they did recheck placement......when in doubt pull it out is the way were taught. I know what you meant, I agreed with your question but sounds like it didn't get done.
zzyzx Posted July 29, 2007 Author Posted July 29, 2007 I ran this call about 9 months ago. Xlnt responses, and yes, we did pull the tube. There was nothing wrong with the tube, as it turns out. So what do you guys think was going on with this patient? :roll:
evjm Posted July 29, 2007 Posted July 29, 2007 Maybe a pneumothorax combined with a diaphragmatic rupture?
AZCEP Posted July 29, 2007 Posted July 29, 2007 Did the abdomen become less distended following NG/OG tube placement? Were you able to ventilate with BLS adjuncts?
Spock Posted July 29, 2007 Posted July 29, 2007 Lot of good comments here so the only thing I would add is if you thought the tube was in the goose you can always confirm placement by looking with the laryngoscope. From what I read it sounds as if the tube was in the goose from the beginning. We have a policy here that whoever intubates transports. We don't have fire department medics (all FD QRS are BLS) so I understand you have different issues. In the interest of continuity of care the FD medic should transport. I don't take anybodys word for proper tube placement especially if they are not transporting. As far as capnography, the waveform is more important than the number when confirming placement (vs-eh pointed that out). Why do you say the tube was OK when you pulled it? The positive capnography readings after soda ingestion is problematic. I have only read one study suggesting this is true and that was an animal study with a small test population. I am not at home so I can't cite the reference right now. Live long and prosper. Spock
zzyzx Posted July 29, 2007 Author Posted July 29, 2007 Kudos to Chbare for getting this so quickly! Yes, the patient an AAA. I ran this call about 9 months ago. Our patient had a cardiac history and took his nitro when he began having chest pain. I remember seeing his bottle of nitro tablets next to his half-eaten dinner plate. He called 911, but before anyone got there, his aneurysm ruptured and he collapsed. His abdomen became progressively more distended not because of gastric insufflation, as I thought, but because our CPR was slowly pumping his entire blood volume into his abdomen. By the time we got him to the ER, his abdomen was HUGELY distended. The poor compliance with the BVM was due to all the pressure against the diaphragm. The loss of the capnography reading was due to there simply not being any blood left to circulate to the lungs. I'm sure some of the veterans on this site have seen this before, but I've never seen anyone with that much blood in his abdomen.
chbare Posted July 29, 2007 Posted July 29, 2007 I have seen this as well. The problem is related to taking a chance with the tube. This is why it is so important to obtain capnography results (Wave form and end tidal number) as soon as you intubate before the patient ceases to produce CO2. It is much harder to argue a good plateau shaped wave form and a reasonable end tidal number; however, it is always safe to error on the the side of safety when you question proper placement. Take care, chbare.
zzyzx Posted July 29, 2007 Author Posted July 29, 2007 We pulled the tube once we lost the capnography reading. Even though the tube turned out to be correctly placed, I think this was the right thing to do considering all the other things that seemed to indicate that the tube was not in the trachea.
mediccjh Posted July 30, 2007 Posted July 30, 2007 If your Spidey senses are uncomfortable with a tube, you're better off pulling it. It's better to walk into the ED with BLS airway management than with a tube in the belly.
chbare Posted July 30, 2007 Posted July 30, 2007 "It's better to walk into the ED with BLS airway management than with a tube in the belly." Word... Take care, chbare.
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