My ICU attending, a more experienced physician who has seen the practice of critical care evolve over decades, left me with an interesting thought yesterday. We discussed a potentially difficult airway and the need to be proactive rather than reactive, especially in the critically ill population.
Anesthesiologists are old or bold but never both.
The younger, more cavalier anesthesiologists will try to intubate with their index finger and a long straw (not really, but you get my point). Boldness is ultimately replaced by experience and understanding the team aspect of ICU medicine. “It’s better to have all hands on deck,” he said, “rather than risk placing a patient in danger.”
In retrospect, the airway was very easy and could have been established by a junior trainee; however, in the grand scheme of things, there will come a day where an unexpected difficult airway could confer serious morbidity or mortality to a patient. And it’s unnecessary. If you expect the best but plan for the worst, one will always place patient safety at the forefront of their actions.
There’s no shame in calling for extra help while you still can (i.e., the difficult airway team in this case). 🙂