This is a continuation of my discussion of this most important topic from my last blog post titled, “ANESTHESIA MALPRACTICE ~ The Deviation in the Standard of Anesthetic Care During Intubation Resulting in Aspiration ~ part one,” whereby I am setting forth some important questions that need to be answered and why these questions are important when faced with a Medical Malpractice Case involving whether or not there was a breach, or deviation, in the standard of care during an intubation that resulted in an aspiration. The important questions are continued as follows:
5.) Prior to Intubation, was it checked whether or not the Patient had Dentures and were the Dentures Removed?
Why is this important? It is vitally important to identify any anatomical abnormality which could not be favorable for a successful intubation of ventilation.
6.) What, if any, measures were taken to make sure that there were no head and/or spinal cord injuries before positioning the head for Intubation?
Why is this important? When performing an intubation on an adult, there is usually a pad or pillow that is positioned under the occiput so that the head is elevated. This will also make sure that the laryngeal, pharyngeal, and the oral structures are aligned.
7.) Was a Rigid Intubation Fiberscope in Use?
Why is this important? In patients where the airway is difficult, a Rigid Intubation Fibroscopes can improve the view of larynx.
8.) Prior to the Intubation was the Patient Provided Pre-Oxygenation?
Why is this important? If intubation proves to be difficult, during the period of apnea and before the tracheal intubation Pre-oxygenation can prevent hypoxia.
9.) During Intubation, was the Sellick’s maneuver performed?
Why is this important? Used successfully and routinely, the Sellick maneuver is used to protect patients during endotracheal intubation from esophageal aspiration and gastric insufflation from positive pressure ventilation.
10.) During Intubation, which, if any, of the Following Basic Physiologic Monitors were Performed?
Why is this important? It is imperative that the following physiologic monitors, that are basic, must be in place prior to the induction of anesthesia and tracheal intubation in the emergency department: 1.) Electrocardiography; 2.) Blood pressure that is not invasive; 3.) Pulse oximetry; 4.) End-tidal carbon dioxide analysis; and 5.) Temperature monitoring.