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A 47-year-old man who'd suffered a cardiac arrest was taken to an emergency department. A code was called. Team members intubated the patient successfully, but they couldn't find a vein for fluid and drug administration.
The code doctor decided to perform a venous cutdown, but he didn't want to delay administering epinephrine. So he elected to give this drug by the endotracheal route.
The doctor handed a syringe of epinephrine, with the needle removed, to a nurse, telling her to "put this in the endotracheal tube." The nurse had never given a drug by this route before. She hesitated a moment, then attached the syringe to the access site for inflating the cuff.
Fortunately, the nurse anesthetist saw what the nurse was doing and stopped her. The anesthetist then correctly instilled the epinephrine directly into the endotracheal tube.
Endotracheal administration of drugs in an emergency has become fairly common, but not everyone is familiar with the procedure. To instill a drug correctly by this route, use sodium chloride injection or sterile water for injection to dilute the drug to a volume of 10 to 25 ml. (This volume appears to provide the best absorption in the shortest amount of time.) Instill the solution into the tube, then follow instillation with several insufflations of air.
Drugs that can be given this way include epinephrine, lidocaine (lignocaine), atropine, and naloxone. Others may be added to the list as endotracheal administration becomes even more common.
Don't be caught unprepared in an emergency. Know how to use the endotracheal route, and make sure your colleagues know the procedure as well.