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“Emergent Endotracheal Intubations In Children: Be Careful If It's Late When You Intubate”


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#1 SerendepitySaki

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Posted 23 November 2010 - 05:14 PM


“Emergent Endotracheal Intubations in Children: Be Careful if It's Late When You Intubate,”

http://www.sccm.org/.../SCCMPod141.mp3
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LET THE WILD RUMPUS BEGIN !!!!!!
Sean G. Smith, RN-Alphabet Soup

#2 FloridaMedic

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Posted 23 November 2010 - 07:58 PM

Interesting in that:

The documentation varies among the professionals at beside as to what is noteworthy or considered a complication.

I'd be curious to know how accurately or what is perceived to be noteworthy for documentation by members here or how you feel about "ratting out" (I believe those were the words used by the Doctor - darn RTs) another team member and if you feel some things can be left out to make someone look good or it is "acceptable" as a "normal" occurrence. We run into this alot when we do rounds or case discussions. For EMS, it is very difficult to do accurate studies since there are not 5 people documenting on an intubation.

There is no Rapid Response Team in a hospital this size. That team is a floor RN's best friend. We (Rapid Response Team with RN & RRT) can be call by anyone, assess and tell the resident we want to take the patient back to the ICU with us. If the resident disagrees, we quickly climb over him to the next level or directly to the attending.

We have a very good intubation success rate at night since the RRTs intubate and sometimes the Residents with RRTs at their side. It is a small group of RRTs who are very closely monitored for skill level and knowledge. If you intubate less than 10 kids a year, you may not be the best choice as a primary intubator and should have a senior experienced provider or be very proficient in alternative devices and minimize repeated attempts at intubation.

Most factors we should already know about such as the differences in anatomy, oxyhemoglobin dissociation curve, cardiac and/or congenital defects, metabolism and oxygen consumption. Obesity in the pediatric population is yet another factor that leads to the importance of having more skilled and knowledgeable providers with broader protocols and tools to overcome this challenge.

It is also to the advantage of many when a hospital (or any agency) is secure enough to openly critique and discuss problem areas within its own walls. Others face similar problems but do take notice when a facility with a good reputation in that professional community addresses its own situations with a call to evalute and find a solution.

Some hospitals have eICUs and other forms of telemedicine. This has been a big help in the smaller hospitals that lack readily available specialists. We also have a video screen we can move around the ICU for conferencing with other physicians during rounds.


Thanks for posting this SerendepitySaki.

The full article is good also as are the other articles that came up with the search. For those interested, some hospitals with a PICU may have an institutional subscription or the local university may have free access (a great reason to be a lifelong student).

http://journals.lww....ywords=intubate
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#3 SerendepitySaki

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Posted 23 November 2010 - 08:29 PM

i LIVE to inform and be informed... B) literally.

i'm all about the "routine open discussion after action debrief" in the name of process improvement...

routine, open critique should be the standard...the RULE, not the exception...

when it comes to patient care, NOTHING is so perfect that it can't be improved upon....

and like you, there were many things said in the clip that i made note of, both "good" and "bad", including the negative semantics of the phrase "ratting out..." also, the toe-dancing around "failing to recognize impending respiratory failure..." *sigh* personal pet peeve...can only imagine how it makes you feel...that is your life! how about using education to compensate for a lack of 24/7 attending/ APRN/PA coverage? there is NO excuse for NOT recognizing impending respiratory failure....NONE.... wish they had talked about aggressively educating the bed-side provider...proactive, not reactive!

thanks for the concise, coherent discussion of some of the various factors that come into play, both with rapid response teams specifically and process improvement in general....

looking forward to hearing what others have to say...
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LET THE WILD RUMPUS BEGIN !!!!!!
Sean G. Smith, RN-Alphabet Soup