Emergency airway management can be fraught with complications related to hemodynamic alterations and airway related complications. Failed or misplaced intubations are some of the most commonly encountered complications of endotracheal intubation. Incorrect placement of the endotracheal tube may result in esophageal or bronchial intubations, which must be recognized and corrected promptly.
Misplaced intubations are more commonly encountered in patients who are assessed to have a difficult airway due to anatomical variations. The critically ill patient is poised to suffer potentially catastrophic consequences of tracheal intubation based on the underlying acute pathologic conditions that had prompted their need for assisted oxygenation and ventilation.
Esophageal intubation, and more specifically, the lack of its recognition, has been identified as a leading adverse respiratory event and is an important contributing factor in the occurrence of hypoxemia, regurgitation and aspiration, severe central neurologic damage, and death.
The incidence of esophageal intubation varies by different reports but is commonly accepted to be in the 2% to 9% range in the emergency setting. Failure to recognize Esophageal Intubation is not limited to inexperienced trainees, and despite the use of verification devices, Esophageal Intubation -related catastrophes persist.
Auscultation of breath sounds, tube condensation, chest wall excursions, reservoir bag compliance and refilling, as well as many other methods of detecting tracheal tube placement are not infallible; each has shortcomings and difficulty with interpretation under normal circumstances. Their usefulness is reduced further under emergent or urgent circumstances.
The use of monitors and the performance of verification maneuvers do not reduce the incidence of Esophageal Intubation, but they may foreshorten the time between misplacement of an Endotracheal tube placement and its detection and correction by repositioning the endotracheal tube.
Esophageal perforation is a rarely reported complication of endotracheal intubation that occurs during unintentional esophageal intubation. Esophageal injuries that occur secondary to endotracheal intubation are usually located in the cervical esophagus. Gastric Perforation has also been reported as a complication of inadvertent esophageal intubation.
Esophageal intubation that cause injury may give rise to a medical malpractice cause of action. If as a result of a physician's or nurse's error your condition worsened or you have been unexpectedly injured, you deserve legal representation. If you are suffering from complications due to an esophageal intubation, let Dr. Borten an experienced trial attorney and also a physician with 35 years of experience fully evaluate the merits of your potential case and the Boston area medical malpractice attorneys at Gorovitz & Borten review the specifics of your case. We can help you assert your rights and get the compensation you deserve.
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