Endotracheal Thinking

My internal dialogue, before intubating a patient:

Well, now, he doesn’t look especially good. That shade of blue isn't healthy. I need to sit him up. Why do people want to lie down when they can’t breathe? I guess I laid down after the workout at the gym yesterday, but that was different. I was seeing imaginary fireflies. Wait, the firefighter is talking to me… Uh huh, CHF history. Got it. Check his breath sounds, Bill. Oooh, nasty! Wet as can be. Rales almost all the way up. Feet? Swolled. JVD? Nope. There is never JVD. People are too fat for JVD. Need to get him moving; ask for the bed. What’s his pressure? Sweet, that is high enough. Give him some nitro. Maybe a little more. A little more. Yay, paramedic dose! At which hospital is he seen? Yeah, not going across the city to that place today. I wonder what caused this guy to overload? What else do I need to do: ECG, IV, pulse ox… Wait, pulse ox is done? Well, what does it say? Crap. Is it really that low, or is it a bad reading. Check the pleth. Crap again, that looks to be a strong wave; the sat is probably true. Is it time for more nitro yet? Nah, not yet. Has he been sick lately? Where was I? Oh yeah, to-do list. Aspirin? Neb would be dumb. Steroids? No. CPAP or intubate him? What other history does he have?

My internal dialogue, after intubating a patient:

Where is the tip of my tube? What does the capnography look like? Where is the tip of my tube? What else do I need to do? Maybe the ECG. Where is the tip of my tube? Keep an eye on dude’s sats and end-tidal reading. Where is the tip of my tube? I need to call to set the hospital up, but it will have to be quick. Where are we going, again? Where is the tip of my tube? What is to eat near that hospital; I’m hungry. Where is the tip of my tube? Why did we just make two left turns in a row? Is my partner lost? Where is the tip of my tube? Has his blood pressure changed? Where is the tip of my tube? Nitro! More nitro! Where is the tip of my tube? IV is in; I need to make sure that doesn’t get away from us. Shut that bad boy down. Where is the tip of my tube? What am I missing? Where is the tip of my tube? Seems like run-of-the-mill pulmonary edema, but what else could it be? Pneumonia? Near drowning? Where is the tip of my tube? What else makes pulmonary edema like this? Where is the tip of my tube? Remember that one fire-medic who insisted on calling both pulmonary edema and pulmonary embolism “PE”? You had to take his meaning from context. Where is the tip of my tube? I think he was usually interchanging the terms. There was no difference in his mind. Where is the tip of my tube? What was that guy's name? Where is the tip of my tube? How much longer to the hospital? Okay, almost there. Where is the tip of my tube? What is his capnography reading? Where is the tip of my tube? What else do I need to do before we get to the hospital to avoid looking stupid? Where is the tip of my tube? Am I ready to give a big room report? Where is the tip of my tube? How old is this dude, again? Born in 1948... duh... carry the one... screw it. Too much math. Where is the tip of my tube? Is the tube still good?

It is pretty distracting to intubate a patient. But I have no esophageal intubations brought into the ED in 20 years of EMS.*

No Goose Tubes!
Original source

*That I know of. When I was attending.