Patient Dies After Unsuccessful Intubation

Case Overview

This case involves a 46-year-old male who presented to the emergency room after experiencing a severe episode of respiratory distress at a local store. Upon arriving at the ER, the patient decompensated further into total respiratory arrest at which point CPR was initiated. The emergency room physicians were unable to intubate the patient and also unable to gain IV line access due to an extremely low blood pressure. After multiple failed attempts at obtaining airway access via endotracheal means, a cricothyroidotomy approach was utilized. Adequate levels of oxygenation were never able to be reached via this ventilation method and it was at this point that anesthesiology was called. The anesthesiologist was able to successfully intubate the patient on the second try but ultimately the patient did not recover from the long term oxygen deprivation and died shortly after successful airway placement.

Questions to the Dentistry expert and their responses

Would this patient have been better served if the physicians on his case called anesthesia soon after they identified him as a difficult intubation?

Any time there is a difficult intubation the attending physician running the code should have a contingency plan in the works. At most institutions, the anesthesia team is alerted when there is a code anywhere in the hospital and they come to assist in such instances. The fact that the physician waited some time to call for help is not in the best interests of the patient.

About the expert

This expert has been preforming endotracheal intubations since 1974 and have been teaching the skill since 1978. He was the supervisor for paramedic training in New York City prior to going to medical school and performed and taught endotracheal intubation to paramedic students and intubated on the streets of the Bronx. For the last twenty years, he has taught two advanced trauma life support (ATLS) courses per year to emergency medicine and surgical residents and attending physicians.

E-000123

Specialties:

Dentistry

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