pulmonary fellow

Tired Critical Care Fellow Accidentally Intubates Patient’s Rectum

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ATLANTA, GA – “Well, this is very embarrassing,” explained pulmonary & critical care fellow Eric Jennings to his colleagues on morning rounds, as he scratched his head.  “I guess I was tired.”  Jennings’ team looked on in stunned silence as they tried to process what Jennings was telling them.  Jennings did something that occurs only in the rarest of circumstances in intensive care units (ICUs) worldwide: he accidentally intubated a patient’s rectum.

pulmonary fellow“I just thought the patient was edentulous with really bad breath,” Jennings continued on, his team still in shock.  “I know, I know.”

Rectal intubation (RI), which is exactly what it sounds like, occurs once every 10,000,000,000 intubations.  The best way to avoid it involves one very simple trick: paying attention.  Not even close attention.  Just any degree of attention.

“Yeah, I wasn’t paying attention,” admitted Jennings with resignation.  “First, I thought, ‘Wow, he’s got really big cheeks, maybe he has mumps or something.’  I noted some oral hemorrhoids, which was new to me.  I had a little trouble on the first pass.  I took the endotracheal tube out and I noted some stool.  I figured, ‘No wonder he’s sick, he’s got some weird esophagocolonic fistula.’  His burps smelled like really bad gas.  It all made sense at the time…”

The truth finally dawned on Jennings when he reviewed the post-intubation X-ray.  He admits he had a “heart attack” or at least “a very small troponin leak.”

“I was shocked how his trachea didn’t divide into left and right main bronchi,” Jennings pointed out on the chest x-ray that was actually an abdominal plain film.  “Then I realized his trachea was mighty tortuous and distended and full of stool, as if it were… and that’s when I knew.”  He let out a defeated sigh.  “And that’s when I knew.”

The first thing any young health care practitioner learns when it comes to invasive procedures is knowing your landmarks.  Landmarks, landmarks, landmarks.  Jennings learned the hard way why in fact landmarks are so crucial.

“As you move through your training, you take landmarks for granted or at least I did,” said Jennings.  “Head and feet.  Next time I intubate or do anything, I’ve always got to identify the head and feet!  Stupid, stupid, stupid!”

Thankfully, Jennings righted his wrong, intubated the patient the correct way, and the patient is currently improving.  Jennings ultimately thinks the underlying process is gastrointestinal in nature; he is waiting on the gastrointestinal (GI) team to call back.

“Let’s hope the GI fellow isn’t as tired as I was,” joked Jennings.  “I’d hate for him to go through what I just went through.”

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