Deviation in the Standard of Anesthetic Care During Intubation Resulting in Neck or Spine Injury

Evaluate breaches in the standard of care when evaluating a Deviation in the Standard of Anesthetic Care During Intubation Resulting in Neck or Spine Injury

Answer the following questions to find out if the standard of care was followed for your case.

  • Was a detailed medical history obtained?
    Yes
    No
    Answer unknown
    Why is this important?
    A thorough medical history is essential to recognize any potential challenges with the intubation. Identification of previous difficult intubations and of any past/current illnesses that could compromise the integrity and anatomy of the upper airway, the jaw, and the neck is paramount.
    (2012) 30 EMDCNA 2 401-420

  • Was a physical examination performed? Why is this important?
    Answer this question
    It is paramount to identify any anatomical abnormality that would be unfavorable for ventilation and intubation.
    (2004) 18 EBPRCA 4 531-548

  • Was an airway assessment performed? Why is this important?
    Answer this question
    The airway assessment includes an examination of the mouth opening, an assessment for restricted neck extension, presence of dentures or loose teeth and a Mallampati scoring evaluation to predict difficult intubation.
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  • Was the intubation for patients with risk factors conducted with extreme caution? Why is this important?
    Answer this question
    Patients presenting with risk factors need to be treated with adequate care to prevent neck and spinal injury.
    (2004) 22 EAMJEM 4 289-293

  • Were the patient’s vital signs monitored? Why is this important?
    Answer this question
    All patients must have pulse oximetry, electrocardiographic (ECG) monitoring, and non-invasive blood pressure monitoring. In hemodynamically unstable patients, at risk of further circulatory disturbance on induction of anesthesia, it may be necessary to insert an intra-arterial access line for continuous invasive blood pressure measurement.
    (2009) 17 EACCEN 3 161-168

  • Which of the following methods of immobilization was used? (Choose all that apply) Why is this important?
    Answer this question
    In the immediate management of any patient with a suspected cervical spine injury, complete cervical spine immobilization is mandatory.
    (2011) 49 ERDCNA 1 129-163

  • Was the patient pre-oxygenated? Why is this important?
    Answer this question
    Pre-oxygenation prior to intubation is the provision of high concentration oxygen to the patient. This technique builds up a reserve of oxygen in the lungs and tissues to compensate for a period of apnea during intubation.
    (2009) 17 EACCEN 3 161-168

  • Which of the following measures were used to accomplish airway management? Why is this important?
    Answer this question
    Airway management is a critical part of the anesthesia practice. Management includes mask ventilation, laryngoscopy, endotracheal intubation and extubation of the patient.
    (2004) 18 EBPRCA 4 531-548

  • Was the endotracheal tube position confirmed? Why is this important?
    Answer this question
    Unrecognized esophageal intubation leads to hypoventilation. Correct positioning of the endotracheal tube needs to be confirmed by the presence of breath sounds in all lung fields and regular carbon dioxide waveforms on the capnometer.
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  • Was a chest x-ray obtained? Why is this important?
    Answer this question
    A post procedural chest x-ray needs to be obtained to confirm the depth of the tube placement and to evaluate for pneumothorax.
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  • Was the procedure documented? Why is this important?
    Answer this question
    Thorough documentation of the intubation technique used, the type and size of the endotracheal tube used, and the confirmation of correct tube placement must be a part of the patient’s permanent medical record.
    (2001) 16 JPANEN 3 195-197