I listed the indications for intubation here. So now I'd like to discuss when a patient really needs to be intubated.
1. Do you intubate all overdose patients who are non responsive? Some doctors say yes. Some hospitals have a policy that they always intubate these patients. Yet I see no point. If the patient is breathing fine, leave the patient alone. A majority of times they recover just fine. Now, of course, common sense is necessary. As I like to say, common sense is better than a policy.
2. Do you intubate a patient who has already aspirated? Well, if the patient is respiratory compromised, surely you intubate. However, if the patient is breathing normal, and the ABGs are normal, then you have no need to intubate because the patient already emptied his stomach contents. Common sense again prevails.
3. Do you intubate ABGs? Again, it depends. We had a patient a few years back who had a pH of 6.9, and she was wheeled upstairs to die (she was a DNR). The next day she was joking with me, and two days later she returned to her nursing home. So you do not necessarily need to intubate bad ABGs. Unlike the NBRC test, you do not intubate a number.
I have seen quite often that doctors panic and intubate patients based on fear rather than common sense. I have seen this many times. And once the patient is intubated, doctors are afraid to extubate, compromising the patient even further.
In a court of law, you will always be fine intubating, so long as you follow your professional guidelines. However, in the realm of things, I think the best doctors will inculcate a milieu of patience, not panic. The best decision for the patient should be made out of ration, rather than out of fear and panic.
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