The Dilemma Of Bloody Intubations

When chest compressions are done, ribs get broken and lungs get ruptured. And it is very common for this to cause blood to come up the respiratory tract. So, as you are bagging, it is common for blood or other bodily fluids to spew into the air around the head of the bed. 

And, once the patient is intubated, blood may come up the tube. More than likely it is frank blood, and it may completely fill the ETT. 

This indicates that suctioning is necessary. You will get the sense that if you don't suction this blood out the patient will drown in his own blood. But when you do suction, you never get it all, because the blood just keeps on coming up. 

But, sometimes suctioning does help. But, more often than not, it does nothing. But, the reason I bring this up, is because when you take the bag off the tube to suction, blood spewes from the tube every time someone pounds on the chest. So, with every compression, blood squirts from the ETT. And this blood can be aerosolized and inhaled. And it can decorate your skin or scrubs or of anyone else in the area. 

So, what I do when I do remove the bag is I use my free hand just over the tube to so the blood that is squirted hits my hand instead of going into the air. And I hope that the person doing the suctioning does it quickly. 

But, I do not like even doing that. So, if I see frank blood filling the tube during compressions, I remove the bag, use my hand to cover the tube, and have a coworker quickly insert a ballard. Then you put the bag over the ballard and bag through the ballard. And if suctioning is needed (which it inevitably will) you just use the inline suction. 

Even then, sometimes it's pointless to suction. There is so much blood you could suction forever and you will never get it all. So it is best to focus your energy somewhere else. Whether not to suction in these cases is a matter of using your own judgement. 

And, in my humble opinion, this is a grim sign. It generally means the code will be called at some point. But, there are always exceptions. 

Another thing I like to do when I know compressions were done, or if I think they may, is to make sure I wear a surgical mask, preferably one with a shield. I generally keep a handfull of surgical masks in my pocket for just these situations.