Should you GOOSE the tube, don’t lose it, USE it!
(Updated 2015-10-04 Yen Chow)
You have a patient with decreased level of consciousness from a closed head injury. They are not protecting their airway and present with active vomiting and gurgling sounds in their airway. You try your best with c-spine precautions and try to position the patient’s head and neck to keep the spine immobilized in alignment (perhaps turned on a backboard). You know that you have to intubate this patient as they are not maintaining their airway and are at high risk of aspiration. Gastric regurgitation continues despite continuous suctioning.
Having extra suctions are always good in this situation to clear the fluids adequately and also as backup in case one suction gets plugged up by particulate matter/fails. If the yankauer plugs up too much consider taking the suction tubing off and sinking the end of it into the airway to suction out the bits.
Here is a tip on using the tubing for high volume suction.
What do you do if your powered suction breaks?
If you have practiced intubations with patients rolled onto their side, you can certainly try to see if you can secure the airway this way however it is not the optimal position. You could consider doing laryngoscopy mainly to help airway clearance and see if you can intubate. I still count this as an intubation attempt even if all you do is use suction.
If you can’t intubate, consider goosing the tube for esophageal diversion and then moving to a better position for optimized look laryngoscopy.