Philadelphia Medical Malpractice: Negligent Intubation

Intubation is a medical procedure that inserts a plastic tube, which runs from a breathing machine, straight into a patient’s lungs. The procedure can be a life-saving one, if done properly, because it bypasses many of the muscles that need to be in working order for the patient to breathe. If any of those muscles are not working or if the patient is unconscious, an intubation can be the only way for them to get the oxygen they need.

However, intubations can be very harmful or even fatal if they are done negligently or improperly. In these cases, you could be the one to suffer from the pain, suffering, and medical issues that result from the negligently performed procedure. Because you were hurt through no fault of your own, there is no reason why you should also be the one to front the costs of your recovery, as well. Hiring experienced medical malpractice and personal injury attorneys to help you get the compensation that you need and deserve can protect your future financial well-being.

How Intubations Work

Breathing might seem like the easiest thing to do. However, the ease with which we inhale and exhale is misleading: There are actually numerous muscles that are involved in the process of sucking air through our nose or mouth, down our throats, and into our lungs, and then sending it back out, again. These muscles work subconsciously, so we do not have to actively think about inhaling and exhaling thousands of times, every day. Instead, it just happens naturally, without us thinking about it.

However, if one of those muscles becomes compromised, or if your throat gets blocked, or if you are rendered unconscious, you could be left completely unable to breathe. This is when you need an intubation, which circumvents the problem by inserting a tube straight into your lungs. Air can then flow freely into your lungs, or can be pumped in and sucked out by a breathing machine, allowing oxygen to continue to circulate through your body, despite your compromised situation.

The exact intubation process that is used, though, will depend on the unique circumstances.

Different Intubation Processes

While intubation is the process of inserting a breathing tube straight into a patient’s lungs, there are several different possible paths for this tube. The path that the tube takes determines the exact type of intubation procedure being done:

• Tracheal intubations are the most common intubation procedures used. These involve pushing a breathing tube through a patient’s nose (a nasotracheal intubation) or mouth (an orotracheal intubation), down their throat, and into their trachea. Air passes through the tube and enters the lungs, at the base of the trachea.
• Tracheostomy intubations use the same process, but begin with a small incision directly on the patient’s throat that cuts through their skin and the outer wall of the trachea. A breathing tube is then pushed through this surgical wound, rather than through the patient’s mouth, and into the patient’s lungs.

Situations that Require an Intubation

There are numerous possible circumstances that require an intubation. However, these can all be distilled into two categories, based on how immediately necessary the intubation has to be done:

• Emergency intubations, where the intubation procedure needs to happen immediately before the patient suffers irreparable harm, and
• Planned intubations, where medical personnel are on hand to oversee the intubation and where the correct equipment is easily accessible.

Emergency Intubations

Emergency intubations are often done in the field by emergency medical technicians (EMTs) when they come across someone who has a blocked airway, or when someone has lost consciousness and cannot breathe on their own. Faced with the emergency situation, EMTs need to perform a potentially life-saving intubation immediately, and are often forced to make split-second decisions in order to save a life.

Unfortunately, many EMTs are not up for the task, and fail to perform the intubation correctly. One study from 2003 found that paramedics who had to perform orotracheal intubations outside the hospital on patients suffering from cardiac arrest symptoms failed 20% of the time. In many of these cases, the patient suffers permanent damage to their throat and esophagus, or face a longer absence of oxygen that can lead to other serious complications. This can be especially frustrating for hurt patients who did not end up needing an emergency intubation, in the first place: The EMT’s decision to perform one was made in error.

Planned Intubations

In contrast with emergency intubations, planned intubations typically happen in the hospital setting, with doctors and nurses on hand.

Most of these planned intubations are done before a surgical procedure that will put a patient under general anesthesia. While the patient is unconscious, they will not be able to control the muscles that let them breathe. Therefore, the patient needs to be intubated and hooked up to a breathing machine, or else the temporary paralysis from the anesthesia will cause them to suffocate.

However, despite the structured setting, the relatively relaxed environment, and the expertise of the medical professionals performing the intubation, planned intubations can still go wrong.

Factors that Make Intubations Dangerous

Despite being one of the most common procedures done in the medical field, today, intubations can still be complicated by factors that make them far more dangerous than normal.

One of the most common factors that medical professionals and EMTs face when performing an intubation is obesity. Obese patients have airways that are often more restricted than non-obese patients, making them far more difficult to manage effectively with a breathing tube. This often results in minor complications from an intubation procedure – like lacerations in the upper airway from the passage of the breathing tube through the throat – but can also lead to far more severe results.

Another important factor in play during intubation procedures is the fact that the doctors and EMTs who perform them are not able to see the breathing tube once it goes down a patient’s throat. This leaves them blind to the passage of the breathing tube into the patient’s trachea, which could prevent them from noticing that the tube has entered the esophagus, instead. If the breathing tube enters the esophagus, instead of the trachea, and the problem goes unnoticed or remains uncorrected, any air that gets pumped into the breathing tube will go into the patient’s stomach, instead of their lungs. Without an adequate oxygen supply, the patient can suffer permanent tissue damage in their extremities.

Complications from Negligent or Failed Intubations

If an intubation is poorly done, there can be many complications and results. While many are minor, there are some that are severe and can even be potentially life-threatening.

The most obvious complication of a failed or negligently performed intubation is the continued inability of a patient to breathe. Intubations are meant to prevent an interruption of air flow to a patient’s lungs or to avoid such an interruption, in the first place. If the intubation fails, the patient continues to be deprived of oxygen. If this is not noticed and corrected, a failed intubation can be fatal as oxygen deprivation sets in and tissues and the brain begin to get damaged. A common situation where this occurs is when a negligently performed intubation sends the breathing tube down the esophagus and into the stomach, where the oxygen that makes it inside the patient proves to be useless, as it cannot be absorbed by the patient’s lungs.

Another serious complication of a negligent intubation can be an involuntary vocal cord spasm, called a laryngospasm. These constrict the airways, like an extended gag reflex, after an intubation, making it impossible to breathe. While a laryngospasm usually only lasts for a minute, some can last for nearly half an hour, making them potentially fatal.

When a poorly performed intubation sends the breathing tube down the wrong pipe and into the esophagus, rather than into the trachea, it can create a whole host of other complications. One of the more serious of these complications is pulmonary edema, which is the accumulation of fluid in the lungs from an intubation down into the esophagus. However, an intubation that goes the wrong way can also lead to pulmonary aspiration, where food and other stomach contents get into the lungs.

Injuries from Negligent Intubations

Because there are so many different kinds of complications from a negligent intubation, there are numerous ways that you can get hurt if one is done to you.

Some of the most common injuries that you can suffer from an intubation are also the most minor. Many if not most of the people who get intubated, whether in a planned or an emergency situation, suffer from very sore throats after the procedure. Many others also have lacerations, scrapes, and bruising in their upper airway, as well as cuts on their lips, gums, cheeks, and tongue, or in their nose and sinuses if the intubation was a nasotracheal one.

Not all injuries from an intubation are so minor, though. Negligent and quickly done intubations commonly lead to severe tooth problems, such as front teeth that get chipped, fractured, or even dislodged during the procedure. These tooth problems can be costly to fix, and can drastically reduce your quality of life until they are repaired fully. Your vocal cords can also get damaged during an intubation, as the breathing tube has to push past them on its way to your lungs. This can traumatize your vocal cords, resulting in swelling and temporary or even permanent weakness and damage.

However, it is the internal injuries that you can suffer from a negligent intubation that are the most severe, or even life-threatening. It is not uncommon for a poorly-performed intubation to perforate your trachea or your esophagus, cutting into the important lining that separates where your breath travels from where your food travels. If this lining gets perforated or damaged, it can cause even more complications, making it difficult to keep air out of your stomach and food out of your lungs, which can lead to intestine or lung problems, or both.

Negligent intubations can also fracture, dislocate, or damage your cervical spine; the part of your spine located in your neck that runs from the join with your shoulders up to your skull. Intubations often rely on the cervical spine to help guide the breathing tube downwards. However, if there is significant pressure on this part of the spine, it can cause the muscles in it to get inflamed, or can even cause damage to the vertebrae, themselves.

There is also an important artery that can be impacted, damaged, or even severed during a negligent intubation: The brachiocephalic artery. This artery, which supplies blood to your head, neck, and right arm, passes across the trachea and can be an obstacle for an intubation tube. While experienced and competent intubators are able to avoid this danger, the artery can be a serious danger for those that are negligently done.

Finally, negligently performed intubations can lead to fatal injuries, as well. If the intubation tube travels down the esophageal tube rather than the trachea, oxygen does not make it to the lungs, preventing it from getting to the other parts of your body. This leads to tissue hypoxia, as your muscles lose access to oxygen. More importantly, it also leads to brain damage as your brain loses its oxygen supply. If an unrecognized esophageal intubation is not corrected, it can be fatal as your body shuts down from oxygen deprivation.

Philadelphia Medical Malpractice Attorneys Can Help

Intubations can be life-saving procedures during an emergency, and can allow important and major surgical procedures to take place. However, when done incorrectly, they can cause medical problems that are more severe than the ones they were meant to help correct. In these cases, you deserve compensation for your losses and the cost of your subsequent recovery.

That is where the Philadelphia medical malpractice attorneys at the law office of Gilman & Bedigian can help. Contact our attorneys online for the legal help you need to get the financial help you deserve.