The hiss of nebs can be heard under the rushing sound of high pressure CPAP. Just as you ponder these thoughts, a seasoned pair of medics burst into the ED. His voice and attitude sound oddly weak, but you remember that the last time he was intubated he developed a pneumothorax …. You think back about his chest x-ray, which showed extensive bilateral pulmonary infiltrates, and wonder how long your luck can hold up before you need to intervene with him. He adamantly refuses ‘the mask' ventilation. He is a frequent flyer with a known history of bad emphysema and a worse attitude. As you resuscitate the crashing asthmatic, your 60-year-old male patient on the other side of the curtain, who has been sleeping comfortably, begins to complain that his breathing is getting worse. Her pleading glance catches yours as you watch her take her last voluntary breath intubation is obviously required … ventilator management is your concern since you realize her life depends on it …. asthma … can't breathe … diaphoretic … giving nebs … No IV … 2-minute ETA." Within minutes, two medics rush in with a diaphoretic cyanotic girl perched forward on her hands. You realize that it's been just a little too quite tonight when the radio suddenly cackles to life: "Teenage girl. In the current age of hospital overcrowding, intubated patients are spending an increasingly longer period of time in the ED at times, they are even weaned and extubated in the ED before a bed becomes available upstairs.
Second, emergency physicians are responsible for both the immediate and short-term care of intubated patients. Indeed, misguided ventilator management can be a patient’s worst enemy and significantly worsen their prognosis. First, appropriate ventilator management improves patient care while a mishandled ventilator is a dangerous tool. Understanding ventilators and their use is an essential competency in emergency medicine. However, post-intubation care (i.e., ventilator management) is often overlooked despite the critical importance of this component to patient outcome. There are numerous courses on airway management, most of which focus on assessment and intubation. ABC or Airway, Breathing, Circulation is a mantra of emergency medicine.
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