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.
Question(s) For Expert Witness
1. Would this patient have been better served if the physicians on his case called anesthesia soon after they identified him as a difficult intubation?
Expert Witness Response E-000123
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.