Learning from Dumb Intubation


In September’s EMS World, your truly wrote an article called 10 Steps to Smarter Intubation. It describes the approach I’ve come to use when thinking about intubating someone.  I’d like to think I was always a smart intubator, but that would be a lie.  I have done some dumb intubating in my career.

Dumb intubating is defined as attempting to place a tube in a patient’s trachea, no matter how difficult that proves to be, no matter what other options are available for airway management, and no matter how little the patient actually needs to have it done.   No matter how long chest compressions get interrupted, no matter how hypoxic the patient gets, or no matter how much the patient gags, dumb intubators believe they succeed if a tube eventually ends up in the right place.

If a patient needs to have a tube in their trachea before we can get them to the hospital, and if it can be done safely –  without compromising their artificial circulation or oxygenation –  then it helps patient.  If that is not possible, something else should be done.

Part of being a professional is recognizing when a procedure is done with the patient’s best interest in mind, and it is done to satisfy a paramedic’s  ego.  Too often intubation is treated as an athletic event or  an opportunity to show off.  And once it starts, there is an erroneous belief it has to be finished, even if damage is done along the way.  Stopping an attempt equals failure.  Dumb intubators go on to attack experts who dare question the wisdom of allowing paramedics to do it.

That used to apply to me, but now I know better.  If we want intubation to remain a tool at our disposal, we need to keep our skills sharp and be smart about when to use it.

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