Endotracheal Intubation

[cali2400]

This woman may have poor peripheral circulation with may be the reason why they are having trouble with the IV. But I don't know why she is trying on the wrist. Mabe she is working distally to proximally to try and find a suitable vein.

[drsaurab]

The tongue is held between the l'scope blade and teeth. wrong . wrong . It should be swept to 1 side.

[ventilator98]

awsome video. Hey what do u mean nurse at the right in trouble with her vein. Im confused on that. I agree. ETco2 is a great monitor to confirm intubation. :)

[searrss]

@ventilator98 What are you confused about? Throughout the entire video there's a nurse struggling to find a vein on the right side of the video... Does that clarify it?

[unkostan]

The Doctor's Scrubs Looks Kinda Too Small For Him.

[Buttsnacks]

Why not listen over the epigastrium first in order to limit possible distension if improperly placed.

[sovietkomrades]

Ok not being rude but why are they doing this? Like what is the outcome of it all? Thanks for your explanation.

[hikerdude4000]

is that lady still with us???

[akocjerzam]

the nurse is having hard time getting her an IV line,,, maybe bec of collapsed veins or needs more IVTraining..

[zyjohn1]

@akocjerzam : agree with NEEDS MORE IV TRAINING...=)

[akocjerzam]

@zyjohn1 hehe ayt bro

[jenniehat234]

Intubation is torture. I was intubated for a sinus surgery when I was 13. 10 years later I still have terrible JAW PAIN from being intubated. I hate doctors.

[drjctmd]

@jenniehat234 Is your sinus problem gone?

[kc958]

Smooth!

[bmsalen]

..e il cateter mount?????? bah

[AikidokaZen]

@bmsalen Probabilmente visto che la pz è in sala operatoria non si usa poichè l'intubazione è di breve durata, solo per intervento.

[bmsalen]

@AikidokaZen no questa risposta non mi soddisfa!!!e quindi quando si userebbe???

[millriseman1]

Smooth intubation, nice!

[levante83]

a very nice job, great!!!

[ManDTee]

the first tool they put in her mouth looked like a machette or something i got scared!!!!

[Gacek88]

i think it's not correct. Doctor should check tube's position by stethoscope, next fill the balloon with air. not otherwise

[mediterraneo1000]

this is a fail, must be cateterized with venoclisis first and after that start all procediments, if a trouble is with a patient, how you administred medicine iv,agrenalina,bicarsodio atropina etc?

[four4vizslas]

@mediterraneo1000 Sometimes druing difficult sticks, a small amount of isoflourine or nirousoxide will "pop-up" difficult veins. The aforementioned gasses are used in pediactric radiology all-time-time before an IV because the kids SCREAM and SCREAM - - the gas allows them to relax a little.

In the USA, Canada and the UK; it is: Aderenaline/Epinephrine - Sodium-bicarbonate - Atropine.

[duard0705]

its the responsibility of the hospital to protect their patients from incompetent staff...especially for training institutions like government hospital theatres. i'm working in a operation theatre,and we have a strict policy for new staffs to have a 3 months observation only policy and he/ she should not scrub or give any medicine(anaesthesia nurses) on any cases unless known to be competent to that surgery...

[biafraforever]

I appreciate your explanation, thanks. Anyways i saw many times in OR lack of respect for patients, i do not like it.

[duard0705]

thank you for appreciation..as of now we are following the WORLD HEALTH ORGANIZATION's time out procedures before the operation,and writing all names of staff involve and responsible for the operation,and insure the privacy of the patient as set by the Canadian Council on Heath Services Administration (CCHSA) for accredited hospital like my institution.

[biafraforever]

I think that when one has to go to surgery in GA, he has to investigate before who are the people who will operate on his/her body; this is now difficult because the hospitals and the medical professionals are still attacched at the patronistic attitude originated with the late middle ages "medicine".

In the current situation, even as you pay a lot of money, you will never know how many incompetent student will touch you when you are sedated and inubated. The only solution is to have a witness.

[usernametaken1932]

@biafraforever @biafraforever from my experience over half of all er physicians hate there jobs. its hard give a shit about the predominantly unappreciative indigent population that sues any chance given. our residents usually "practice" on our "regulars" that are expected everyday. i have now left the er as i became colder and colder. in some sort of sick way i enjoyed seeing the thug piece of shits flop around for a few minutes before intubation

[biafraforever]

@usernametaken1932

I would not thrust people like you even for delivering the puppies of a bitch. Good luck to your patients :(

[usernametaken1932]

i live and work in georgia... you just may be one of my patients. i take great care of my patients! except the ones that are not appreciative and call me a white piece of shit. i will stop now. you could never understand where im coming from unless you came 2 work with me for a day. good day

[whittvet]

@biafraforever If you come out better than you went in then you win. If we don't have "incompetent" students then we will have incompetent students. I think you are an alarmist.

[raeins]

i hate the fucking mandrin ;)

[Matias268]

i use always mandrin when doing intubation ( is easier)

[NONSTEMI]

people, this is a 2nd or 3rd line, not only no one should do induction without iv line, but nowadays it's impossible, due to fact that every induction med that goes in, goes through iv. but then again, it just might be a nurse student, or med student or trickie veins...

[blouin22]

That nurse would be terrible in paramedicine, new or not, you can not be that slow!

[whittvet]

How do you know? Maybe she was just trying to get past a blow or trying to pass a valve. Don't tell me that you have never missed an IV. What if this is just a second line? (which I am sure that it is) Some of the worst people I have seen do IV's were paramedics. Some of the best I have seen were paramedics. Point is you were not there to see what she was doing.

[joekaps1210]

That is a Cadavar!

[crazydaisy999]

OMG was that the only potential Venous access point? Why did they proceed with the induction? What if the subject had crashed? Oh Dear!

[whittvet]

I have a feeling it was not. How would they have given the drugs to put her down?

[whittvet]

Im sorry. I was thinking RSI, but I bet it was just a second line for back up. I can not see putting someone down without an IV.

[fatamorganaa84]

omg, whats up with the nurse, ha-ha :)

[crisb82]

this is crap intubation.....my attending will kick my ass for that

[chopped50]

never proceed with induction if you have no IV access,basic rule of anesthesia,its an iv not a a line its on the ulnar side not the radial side.You can gas down kids due to alot of fat that hides veins,but this is no kid.If she crashed on induction shes screwed good luck giving intramuscular resus drugs in that scenerio!

[AJHcorolla]

to those who are saying it is an artline look again 1 its on the wron side and 2 it is a ECG electrodes unless you are all refering to the IV canula on the patients Wrist

[thecrowcsplayer]

Patient is Sedated and Intubated before the Canula is placed? Risky

[clevelandw25]

they let go of the tube they would fall their EMT-P NR.

[whittvet]

Yep, but he did not fail his MD

[foch41]

DR.'s been working out lol

[sparky28546]

That doesn't look like an IV the RN's putting in...it looks like an arterial line. They are a bit harder to put in.

[scartw01]

Nope, it's an IV.

1) it's on the ulnar side of the arm (a possible, but highly unusual location for an art line)

2) there is a tourniquet up (required for venous access but not for arterial)

[doctorkaraca]

Good luck trying to find the radial artery on the medial side of the wrist/forearm!

[bmccse]

Agreed. Looks like an IV. It's on the ulnar side. Anyhow a-lines are not that difficult after you do a hundred or so. They are considered difficult by people who don't do them often

[TheNexus]

or that nurse might just be new :P

[GastonFranquin1]

@sparky28546

RN is not allowed/competent to place A line

I often see surgery resident or RT place them in in the ICU (in the OR I do not know who does it but it should not be a nurse)

[NONSTEMI]

somebody should have been holding on to the tube wail doc was auscultating, it could have been pulled out... and poor nurse and iv cannula :D

[nurseDavide]

Yeah!! the nurse take some minutes :) real ER nurse :D

[hybridracers]

Im surprised that they dont use end tidal co2 capnography on this, it should be a standard practice in any OR

[mill2mac3]

hybridracers -They are using end tidal CO2. On the circuit there is a clear, thin plastic line attached to a small light green connector. This is the gas sampling line. Exhaled CO2, volatile agent (if being used) and N20 are being measured through this. CO2 is displayed as an absolute value and on a capnograph.  I agree with you. It should be standard practice in any O.R. today.

[hybridracers]

Im not too keen to the OR version of capnography being Im a paramedic. Our system isnt that small and I have a hard time believing that this one is able to be that small. Further more, the subject says that this is a combitube and it definetly not. Cheers anyways.

[cartozian1638]

the version you use is probably a qualitative etco2 detector, that turns purple or whatever when co2 is detected. This is a qualitative detector, that tube is the sampling line. it connects to the monitor and provides a nice waveform.

[mikebluffer]

i thought the resp therapist handles the ventilators.

[GastonFranquin1]

@mikebluffer

this is OR and anesthesia machine which can handle anesthetic gases;;RT work in the ICU

[emeraldking18]

What was that blue thing in the beginning?

[xinghutttrwhoper]

it's a tongue guard or airway.

[FireSarge30]

This is clearly an ET tube, not a combitube. Also, you don't use a laryngyscope with a combitube.

[exon112]

That's an ET tube, not a combitube.

[red2rn]

he was auscultating the lungs to check if the ET tube was really in the lungs, That's why you can clearly see the bilateral rise and fall of the chest, which indicates a correct placement of the tube.

[skiaffa]

he was auscultating to check that the ET tube was in the trachea and not in one of the bronchus because there's the risk that only one of the lungs is ventilate.

[elbombacho]

wow that is amazing. but one question, the person who is holding the bag valve mask and giving respirations, I noticed that he was auscultating the lungs rather than checking the stomach first?

[nurseDavide]

There is a video in 3D about intubation, here on youtube. search it, you'll see that it shows this way...lungs and after stomach.

[markgreencarter]

it's so strange after intubation, another nurse is canulating the vein!!!how can do sedation?only by gas?

[nurseDavide]

maybe she must administer a fluid that could give a reaction if given with the anestetic.

[agentsplat]

Very possible the patient already has an IV in the other arm. I've seen second IVs started for various reasons during induction of anesthesia.

[shyammadabhushi]

Yes. Adult mask induction can be adequately done with sevoflurane. The administering of muscle relaxant is tricky though. Guess one may use intramuscular succinylcholine. But why take all the trouble?

[wuppal999]

and finally, the position of the ET tube looks perfect. You can clearly see bilateral rise and fall of the chest indicating a correctly placed tube.

I dont know where people get these things from. Are you St John Ambulance or something???!!!??

[Nap2DadeC]

LOL I thought I was the only person reading these comments like what the hell? That is clearly a HME at the end of the tube, an ET-CO2 detector doesn't even look like that.

[wuppal999]

secondly, ET tubes do not go down sideways, I dont know where you got that from????

[wuppal999]

Firstly, the piece of equipment on the end of the ET tube is a heat & moisture exchanger (HME) designed to heat and moisten the gases being delivered (basically mimicking the functions of the nose)

[lmirra]

this is not a combi-tube, rather, it is a normal ET tube with a ETCO2 Monitor on the end.

[ernursedave]

Thank you for your notice!

[mucomyst]

If that tube is 2-3 cm above the carina I will chop my dick off!

[CDFdavid]

just curious but shouldnt the endo tube not go down sideways?