Field intubations are tricky.
Anesthesiologists like to talk about first pass rates on 12 hour fasted chemically sedated patients in a well lit room at table height. Dude, if you miss those something ain’t right.
We know from experience hitting the doors of the ED with a dirt covered ET tube holder and a solid ETCO2 waveform is a badge of honor. Heck, hitting the door with good chest rise and a BVM is just as nice, but when we begin to relate the difficulties in clearing, securing and then ventilating through a challenge airway, some Docs seem to shake their heads at us as if we were telling them a tale about being chased by a giant dragon.
One crew recently decided to bring some evidence with them to the ED.
A local skilled nursing facility seems to have been feeding a dead man.
First engine on scene requests a Captain and transmits CPR in progress. The engine medic notes extreme difficulty in clearing the oropharynx of a dry mush-like substance, grey in color, which seems to ooze more as soon as some is scooped out.
Ventilations are not even useful and a few abdominal thrusts are performed which seem to clear most of the blockage.
The patient is pulseless so chest compressions are started and it seems to be helping. Not seeing a chance to get the airway clear enough for the BVM (“Emesis too dry and chunky for suction”) the ambulance medic has a grand idea:
Attempt laryngoscopy and suction the tube of the contents.
First attempt yields a placement and no air movement is noted, so they pull it and are almost shocked to see a perfect core sample (their words, not mine) of what is blocking this airway. The decision is made to use a KING LT and hope most of the blockage is now inside the withdrawn ET tube.
The BVM moves air, the chest rises, and they’re off the the ED to explain this airway.
When the ED Doc seems not too convinced the airway was as difficult as they described, the Medic produces the ET tube from earlier and describes the various layers of foods that were lodged in the trachea.
Core sample intubation. You heard it here first.