First Tube!

Today was a very exciting and educational day for me on the ambulance. As a Critical Care Nurse I have the ability to perform a procedure called RSI, but rarely the opportunity. This is a procedure that I'm not allowed to do in the ER. For all you non-medical people (ok, ALL of you!) RSI stands for Rapid Sequence Intubation and is used when people are still alive but not awake or alert. Most of the time it's used when people can't maintain their own airway and need help from us. So we give them a series of drugs to sedate and paralyze the patient and then put a tube in their trachea to breathe for them. Most patients that I transport are either already intubated or the transport is so short they don't have a chance to crash on me (too badly!). Needless to say, I haven't had the opportunity to perform this procedure except on a dummy. Until today...

We ran a 911 call this morning on an unresponsive man. We're not sure what exactly was going on with him, but he was definitely not awake or alert. So we dropped him off at the hospital and stuck around a little to help the ER staff with him. We were just about to leave when my medic came up to me and told me they were going to RSI the patient and I should ask if I could do it. I told him they probably wouldn't let me and we shouldn't bug the resident (yeah, I was really nervous). But this was a teaching hospital and Brian really wanted me to go in there and do it. Now Brian is normally very much the Southern gentleman, but on this occasion practically grabbed my arm and forced me back into the ER.


So I went inside and asked the resident if I could do the RSI. He said sure. This particular doc was a third year resident and his attending wanted him to have some practice teaching procedures to other people, so it really worked out well for everyone! We set everything up, discussed which drugs we wanted to give and in what order and my hands began to shake. Badly. The way they did back in nursing school when I started my very first IV. Hopefully no one noticed. So the ER nurse gave the drugs and the guy was well paralyzed. The picture here shows the instruments that we use. The laryngoscope has a light on it so you can push the tongue and the epiglottis out of the way and see the vocal cords. And then the tube is passed just through the cords so that both lungs can be ventilated. It's pretty difficult to get it in the right spot because a lot of times it slips down into the esophagaus and ventilates the stomach - not very helpful for the patient!

The first look I took was very much blocked by the man's tongue, so the doctor gave me a longer laryngoscope blade and told me to look again. This time I saw cords and passed the tube - in the right spot on the first try! The doc and the attending were so nice. They both told me I did a great job and were so helpful in talking me through the whole process. The ER where I work is not a teaching hospital, and you can definitely tell the difference in the attitude towards learning procedures like this. I don't think I'll be quite so hesitant to ask to assist on procedures next time we're in this particular ER. Plus we're getting to know all the docs and nurses so they are more comfortable with us coming in and helping out!

So that was my exciting day. Not that it sounds particularly exciting when I spell it all out like this, but it was a great day for me nonetheless! Yes, I'm an adrenaline junkie. Shocker. Now on to my next 5 shifts in a row...