I was teaching an SRMO the other day. We were discussing the new idea of two person confirmation of tracheal intubation. (A la Dr Tim Cook and the case of Glenda Lonsdale, a name that should go into the anaesthetic lexicon along with Elaine Bromiley and Gordon Ewing) to avoid unrecognised oesophageal intubation.
We used a videolaryngoscope to intubate an entirely straightforward patient. The view was easy. The SRMO intubated first pass and as is common, obscured the view with the endotracheal tube on the way in. But I confirmed placement through the cords with a lift of the laryngoscope blade.
The SRMO saw two peaks of carbon dioxide and started to tie the tube in. I then pulled him back and confirmed placement by two person check and confirmation of six carbon dioxide waveforms. This is a new practice and hasn’t entered the general milieu of anaesthesia yet and definitely not amongst the anaesthetic assistants.
And as we talked it through and the reasoning behind what we were doing, I could see the disaster as it might have been…
Imagine, you’re a junior anaesthetist, you intubate a 140kg patient, the tube went into the trachea, but the actual view was obscured by the endotracheal tube itself and the epiglottis is resting on the tube so you never actually saw the actual vocal cords.
You turn to the anaesthetic machine and see two uneven peaks of carbon dioxide and return to the patient to secure the tube.
But it turns out you were wrong, you didn’t lift the videolaryngoscope up to view the cords, and the carbon dioxide you saw was the air that had insufflated the stomach coming back.
You start to prepare antibiotics or write the chart as many of my junior colleagues seem to do…
And then you’re down the vortex aren’t you.
It was quite the teachable moment