Whether it is for a routine procedure, such as the removal of impacted wisdom teeth, or for an emergent reason, such as loss of consciousness following a car accident, many of us or our loved ones have been intubated while receiving medical care. Intubation is the use of a tube and ventilator to help patients get air into and out of their lungs.
When we breathe, our lungs receive oxygen and move it into our bloodstream. When we exhale, our lungs remove carbon dioxide from our bloodstream and pass it out of our body. This process provides our bodies with necessary oxygenation and keeps us alive. Intubation allows medical professionals to simulate this process when patients, for whatever reason, cannot do so themselves.
Endotracheal intubation is when intubation is accomplished by passing the tube through the patient’s mouth and into the trachea. Nasal intubation, which is usually reserved for when a patient is having surgery on the mouth or throat, is when intubation is accomplished through the nasal passageway. Like any procedure, intubation is accompanied with risks and complications, which include:
- Damage to teeth, lips, tongue, trachea, and/or larynx;
- Difficulty breathing after extubation (removal of tube);
- Insertion of the tube into the esophagus/stomach;
- Too much or too little ventilation;
- Collapsed or injured lung; and
Serious Injury, Disability, Death as a Result of Failure to Intubate or to Properly Intubate
Airway management is an essential skill that all emergency department medical professionals should possess. Failure to secure an adequate airway inhibits the patient’s ability to receive adequate oxygen and can lead to serious injury, disability, and/or death. Physicians and nurses working in an emergency department should recognize when patients require intubation. Patients requiring intubation usually present with at least one of the following characteristics:
- Inability to maintain an open airway;
- Inability to protect the airway from aspiration;
- Compromised ventilation;
- Failure to adequately oxygenate blood; and/or
- Anticipation of a deteriorating condition or course of hospitalization that will lead to the patient’s inability to maintain an open airway or protect it from aspiration.
Planned Surgery vs Urgent Emergency Care
Patients who present for surgery are usually intubated while under sedation and have fasted in anticipation of the procedure per their physician’s instructions. However, patients who present for emergent care have not fasted and are not necessarily sedated or unconscious. Rapid sequence intubation (RSI) is the preferred method of emergency department intubation. RSI involves the induction of unconsciousness and paralysis within a minute or so through the administration of neuromuscular blocking medications and other agents.
When performed by well-trained, experienced medical professions, RSI reduces the risk of complications typically associated with emergent tracheal intubation. On the other hand, when an unconscious and apneic (not breathing) patient presents to the emergency department, bag-valve-mask ventilation and endotracheal intubation without pretreatment, induction, or paralysis is appropriate due to the urgency of the situation.
Failing to intubate, or failing to properly intubate, can cause serious injuries, including:
- Brain damage;
- Cardiovascular failure;
- Neurologic compromise; and
- Lifelong disabilities.
If a patient is seriously injured due to a physician’s, nurse’s, or other staff member’s failure to intubate a patient who required it, the patient and/or the patient’s loved ones can be left with expensive hospital bills, future costs of care for the patient, loss of income, and possibly the loss of a loved one. When a physician provides treatment to a patient that falls below the standard of care, he or she can be held responsible for the consequences of their carelessness. Further, hospitals and medical centers can be held liable for the negligence of their employees, which is known as vicarious liability. In addition to vicarious liability, hospitals and medical centers can be held corporately liable for failing to ensure patient safety and quality of care. This includes failing to adopt appropriate policies and procedures that establish guidelines for when a patient requires intubation and procedures following failed intubation.
With all legal actions, it is important to consider the time limitations of the relevant jurisdiction. In Pennsylvania, there is a 2 year statute of limitations for medical malpractice cases, normally beginning from the date of the injury. Further, Pennsylvania imposes a 7 year statute of repose, which extinguishes all medical malpractice claims after 7 years from the date of the injury regardless of when the injury was discovered. Like Pennsylvania, New Jersey imposes a 2 year statute of limitations, but New Jersey does not have a statute of repose. Contacting an attorney sooner, rather than later, is best practice because it allows the attorney to fully investigate the matter while the evidence is still fresh, and it provides the attorney with the necessary time to discuss your case with medical experts.
A medical malpractice attorney with experience and skill in handling intubation cases is necessary to help a wrongfully injured person obtain the compensation that is deserved in a situation such as this. For decades, Slade McLaughlin and Paul Lauricella have represented clients in medical malpractice cases and have secured large settlements and jury verdicts for their clients.