Turning over intubated patients

[Turk II]

Scenario: A medic intubates a patient in the field. (Unresponsive, nasal, or RSI... doesn't matter). Patient is transported without incident and the crew arrives at the ED. Paramedic is met in the ED room by a nurse. No doc... no RTT...

Would you feel comfortable handing over this patient to a nurse?

We had this discussion at my job... the yeah-sayers argue that this is acceptable because nurses are able to maintain and monitor intubated patients.

The neigh-sayers say this isn't acceptable because nurses are not able to intubate and therefore in this case the medic is turning over care to a lower-certified provider.

What would you think?

[Philly Medic]

We notifiy the receiving hospital that we are enroute with an intubated pt and to have respiratory standing by. Never had to just hand over to a nurse plus don't think they would want and continue to bag the pt.

[kjrff23]

Personally I wouldn't feel comfortable, but they do sign our run sheets normally. If they can drive an ambu bag I'd say legally they have every right and responsibility to receive that patient. Of course this could vary from facility to facility.

[jdemaio]

Personally I wouldn't feel comfortable, but they do sign our run sheets normally. If they can drive an ambu bag I'd say legally they have every right and responsibility to receive that patient. Of course this could vary from facility to facility.
Absolutely, but to cover your butt, wouldn't you want the MD to listen to the Pt's lungs when you hit the ED to confirm tube placement?

[paragoon]

That's an interesting scenario. On my last shift, we had to RSI a patient. When we radioed to the ED informing them that we had a priority-1 patient onboard and RSI had been performed. ED said they received our transmission, but when we arrived... they claimed we did not inform them. This happened on Sunday, so the ED doc was the only one in the hospital. If he hadn't already been there to verify placement, I'm not sure who I would have turned my tube over to.
I'm gonna bring that up at the next crew meeting.

[jdemaio]

That's an interesting scenario. On my last shift, we had to RSI a patient. When we radioed to the ED informing them that we had a priority-1 patient onboard and RSI had been performed. ED said they received our transmission, but when we arrived... they claimed we did not inform them. This happened on Sunday, so the ED doc was the only one in the hospital. If he hadn't already been there to verify placement, I'm not sure who I would have turned my tube over to.
I'm gonna bring that up at the next crew meeting.
Yeah, that's a huge liability. Good idea to bring it up, I wouldn't wait to bring it up either, i'd write an incident report, just to cover your butt in case the ED staff calls in saying that you never advised them of your patient.

[kjrff23]

Absolutely, but to cover your butt, wouldn't you want the MD to listen to the Pt's lungs when you hit the ED to confirm tube placement?
I think I'd do it again right after the move onto their cot, check the lip line, tube fogging and if there was an ETCO2 cap on it even better. And add that all in to my report to said RN as well. I'd make her/him listen too.

[Lt. Smiley]

When I bring in a tubed patient the doctor is generally getting in my way of transfering them. I guess that the doctors around here get tired of treating colds and flu that when they see a patient with the plastic hanging out their mouth it is like a kid getting candy.

[1medicprincess]

You know I have not run into this problem before. I have picked up a pt in the ed with burns and on a vent and the only person in the room was the nurse (resp was no where to be found) We removed them from the vent and put in on our portable vent and he did have rsi on board. When I have brought in a tubed pt I have all ways had the ed doc and a nurse and a resp person there, but the nurse has all ways signed my pcr. I know that our here the ed nurses have to have acls when they take this class don't they have an area that goes over intubation so that they are able to tube a pt it need be?

[anthonyt]

Scenario: A medic intubates a patient in the field. (Unresponsive, nasal, or RSI... doesn't matter). Patient is transported without incident and the crew arrives at the ED. Paramedic is met in the ED room by a nurse. No doc... no RTT...

Would you feel comfortable handing over this patient to a nurse?

We had this discussion at my job... the yeah-sayers argue that this is acceptable because nurses are able to maintain and monitor intubated patients.

The neigh-sayers say this isn't acceptable because nurses are not able to intubate and therefore in this case the medic is turning over care to a lower-certified provider.

What would you think?

While a nurse can monitor an intubated patient, the care for that patient is vested in the physician. Nurses cannot extubate, intubate, or adjust ett's , other than to pull the patient off a vent and use a bvm...

I would not turn this patient over to a nurse. Nurses exist and work at the will of the physician, we are an extension of the physician. When you perform physician level skills, you should turn your patient over to a physician.

[jdemaio]

While a nurse can monitor an intubated patient, the care for that patient is vested in the physician. Nurses cannot extubate, intubate, or adjust ett's , other than to pull the patient off a vent and use a bvm...

I would not turn this patient over to a nurse. Nurses exist and work at the will of the physician, we are an extension of the physician. When you perform physician level skills, you should turn your patient over to a physician.
I guess that was what I was trying to say, but I just could not put it as eloquently as he did.

[Trey]

Everyone is talking about RSI... In Georgia only a Critical Care RN can do RSI in the field.. and they are only found on the Air services.. no ground unit can do RSI..

[jdemaio]

Everyone is talking about RSI... In Georgia only a Critical Care RN can do RSI in the field.. and they are only found on the Air services.. no ground unit can do RSI..
When are the OEMS office staff planning on coming out from their cave?

[Trey]

I don't know.. that is just how it is... we still have crap that is required to be on our trucks that should have came off ages ago.. When is the last time you used a PASG??? or do people even know what that is anymore?

[medic pathetic]

I don't know.. that is just how it is... we still have crap that is required to be on our trucks that should have came off ages ago.. When is the last time you used a PASG??? or do people even know what that is anymore?

I was taught how to use them when i got my cert. But i think they were talken off the truck before i actually got my cert in the mail.

Same for us with activated charcoal, we don't get that stuff anymore either.

[Trey]

Activated charcoal usually causes vomiting... and vomit can obstruct the airway.. that was a dumb idea to begin with.. and ipecac as well..

[jdemaio]

When is the last time you used a PASG??? or do people even know what that is anymore?
I used PSAG not too long ago, I was taught by a dinosaur who loves 'em. Now, I just learned that the reccomendation for using them for bilateral leg injuries has been withdrawn, they'll probobly be pulled from the trucks soon.

Same for us with activated charcoal, we don't get that stuff anymore either.
I have given that a couple times in the last year or so too.

Activated charcoal usually causes vomiting.
Ipecac causes vomiting, charcoal usually doesn't cause vomiting. I see the RNs give it in the ED on a pretty regular basis and I've given it a few times, never seen anyone vomit. However, Loyola Univ. says that about 1/4 of everyone that has been given charcoal vomits...still, I've never seen it.

[Trey]

Ipecac causes vomiting, charcoal usually doesn't cause vomiting. I see the RNs give it in the ED on a pretty regular basis and I've given it a few times, never seen anyone vomit. However, Loyola Univ. says that about 1/4 of everyone that has been given charcoal vomits...still, I've never seen it.

I have only been an EMT for about 4 months.. I am only 20 years old.. but I have given activated charcoal twice.. and both times they vomited..

[medichughes]

I am ok with handing over care to a nurse. Once i give my report, not my problem, but i might hang around just in case chaos happens. Where i work there is always a doctor that comes and gets report if the patient required intubation.

[SgtComic]

I personally want the MD to confirm placement. I brought an arrest in yesterday, had an 8 ETT at 26cm....the nurse almost yanked the tube out taking over the ambu from my parnter. Yup...guess who would have been blamed for a misplaced tube?

[kjrff23]

Activated charcoal usually causes vomiting... and vomit can obstruct the airway.. that was a dumb idea to begin with.. and ipecac as well..
You should be giving activated charcoal PO to an alert and oriented patient anyway. Anyone A/OX3 should be able to protect thier own airway. I've never seen anyone vomit with activated charcoal either.

[medic pathetic]

I've only given it or seen it given in the ER when i was a student about 5 times or so. Only one person didn't gag and/or throw it up, and that one was a 'regular.' You may as well have given her a chocolate milkshake. I think though that people do it out of being upset, not necessairily because they can't drink it. We give it to them and tell them if they puke they are cleaning it up and drinkingmore anyways, or they'll get a tube to pump it into their stomach bigger then the one we just used to pump the other crap out. That method worked every time.

[anthonyt]

I have only been an EMT for about 4 months.. I am only 20 years old.. but I have given activated charcoal twice.. and both times they vomited..

I have given charcoal, several times (more than I have ever cared to count), and have seen only two people yak it up.

[paragoon]

When I worked in the ER, I've seen a few patients puke the charcoal up. Usually after they had done gastric lavage on the person. Children are usually good about keeping that stuff down. We use to mix it up in Coca Cola bottles. I've always been cautious about giving it to people out in the field, because of risks to the airway, and it's not always the most effective treatment for OD's, I guess it's used as one of those teachable moments.