My First Intubation

Though I've intubated a few times during my residency it really doesn't count because, I was never alone. My backup with loads of experience was standing right next to me. We also had a videolaryngoscope and a fibreoptic bronchoscope just in case. But once I was out of Medschool, I was all alone, on my own.

   I got into my job right the next day of getting registered to the Medical Council (just bragging). My designation was "Emergency Care Physician" in an Emergency Care and Stabilization Centre in Chennai.Chennai as you may know is a large city with a huge population and hence a huge TRAFFIC. In case of any emergency, shifting the patient from the scene to a tertiary care centre costed the valuable 'golden hours' and mortality was pretty high. To overcome this, Govt came up with the idea of Emergency Care Centres scattered within the city,which would serve as stabilization centres and I started my career in one such centre.

It was my second week of joining duty, and only me and 2 paramedics were on, for that shift. I could hear an ambulance siren blaring, which is unusual as ambulances usually switch off their sirens, when they near the hospital. At once, We knew some very sick patient is on the way and We buckled up.

A 16 year old girl with school uniform was wheeled in with a history of suicidal hanging, at her home. She was unconscious and gasping for air. My team sprung into action, I put on the sterile glove and mask.The second she was wheeled in, I knew she needs a tube.

My team attached the monitors, put on an oxygen mask and was getting IV access. I asked the one of them to get the intubation tray ready. By then I was on the headside of my patient and was looking at the monitor. Her SpO2 was only 63% desaturating despite the high flow oxygen she was put on. Immediately I started her on Bag and Mask ventillation, which is actually not very ideal in a emergency setting due to the risk of insufflation of stomach causing vomiting leading to aspiration of the vomitus into the lungs,which would lead to deep trouble. But We had no other Go. Deep inside, I was very nervous,as this was truly my first intubation, all alone by myself with no backup or backup many minutes away which we couldn't afford.

As I always do, I prayed for an easy intubation, vocal cords be easily visible and not to go down the esophagus.

I asked my staff, "Scope with 3 blade please" Got the blade locked up in posistion and slid it into her mouth taking care not to injure her lips, teeth or tongue. I could see nothing inside as it was filled with secretions. Asked, "Suction please" Got the suction catheter in my right hand, and got the secretions clear.

Even then, I could see nothing but pink mush and no cord. I tried to adjust the blade to and fro and tried lifting the jaw but in vain. I was anxious, my heart was pounding and my forehead was perspirating as she was desaturating.

Just then, One of my experienced staff, did the BURP maneuver, and her vocal cords appeared magically in the view of my laryngoscope. I was never this happy on managing a patient before.I asked for "Tube Tube", got the tube which I swiftly passed through her vocal cords into her trachea and could instantly see vapour condensation inside the tube.

I was so much relieved and I was very confident it was inside her trachea as I directly visualized it going in. Asked for my steth and checked for equal air entry in both sides and also checked the epigastrium for any gurgling.

I connected her to the ventillator,gave all necessary medications and kept her on observation till the ambulance arrived and then shifted her to a tertiary care centre.

I followed her up through phone,she was extubated after 2 days,and discharged home after a week, and was doing fine.

After this I hav intubated more than a couple of hundred cases in this two years, But I would never forget my First intubation which was a leap in my career. Hope You enjoyed the ride and do checkout my blog about Easy intubation tips.Keep Medizening..!!

Dr.Praful JK, MBBS