First ED Intubation

I did it! The first of what will eventually be a daily normal event in my career. I intubated a patient in the emergency department. I did it with the attending behing me and many people watching, waiting for me. Not to mention the patient that was de-sating on the gourney... Here's a detailed account of an event I will NEVER forget:

He came in by EMS gasping for air. As we hooked him up to the monitors and got IVs started on him all he could say was “im dying, please don’t let me die.” He looked like crap. He was using every accessory muscle he had to breath and even still satting in the 80s. Dr. R told me to sign up for him, he was going to be my patient. We discussed what was going on with him and what we were going to do with him. First we will try bipap lots of nitro, lots of lasix and then if he still is not improving we will probably have to intubate him. After giving him 30 minutes on bipap and lots of medications later, he was still not improving. I was sitting in the front charting on a computer when Dr. R walked up to me:

“Dorothy, we’re gonna need to intubate your patient.”
“Ok. Yeah I agree, he still looks like crap. So, what kinda blade do you like to use?”
“Doesnt matter to me. Your the one thats gonna be doing it.”
[huge smile on my face]
“Have you done this before?”
“Ive done an anesthesia rotation and intubated in the OR but not in the ED. This was be my first”
“OK well lets go. Theres a first time for everything and this might as well be it. ”

We walked into the patient's room and there were a couple nurses, the respiratory therapist, Dr. R, me, and of course the worsening patient. I tried to remain calm and not let my heart rate sky rocket but it was inevitable, i was pretty nervous. I got my equipment together, checked the light on my blade, got a 7.0 ET tube and put in my stillette. Got my ambu bag ready and we discussed what meds we were going to use. The whole time Dr. R was being his normal, semi-abbrassive self [which i was pretty use to at that point, i knew it was all a big act]. He was trying to make it a lil more stressful just to see how I dealt with the situation i think. We were about to push the meds and everyone went quiet and I had at least 7 pairs of eyes on me by this point.

Dr. R leaned over to me and not too softly said, “Im only gonna say two things to you: if you dont see the chords, dont try to pass the tube. and dont fuck this up.” [he then smiled and that was his way of letting me know he was there to help if i needed it]

“Yes Sir”

We pushed the Etomidate, then the Succ, we waited for him to de-fasiculate and then it was showtime. I saw his chest stop rising and no more condensation on the ambu bag. I took it off and confidently put in the Mac 4, lifted up towards the corner of the room and then looked for the chords. It took about 15 seconds [which felt like eternity] and I heard Dr. R say "what do you see?"

"epiglottis” I pulled back a little bit and then said “tube please.”

“you sure you see them?”

[in a much more confident and authoritative voice] I said “Yes, I see the chords, tube please”

I didnt take my eyes off the chords and someone placed the ET tube in my hand. I slid it in and watched it go between the chords. I gently took the mac blade out, hooked up the CO2 monitor, someone inflated the cuff and we watched for color change.

“good color change” -resp therapist announced

Dr. R took the blade and looked to make sure the tube was placed in the right spot.

“yup she got it. good job”

Thats all he said but i knew he was proud of me. I did it. I intubated my first patient in the ED, on my first attempt ever. Damn i felt like a rockstar.

and so my career as an ED doc has begun...