When do we stop worrying about blindly intubating??

So I go in for a treadmill tomorrow.  Normal test.  They also will run the dye (contrast) through my heart.  Those who have had this done, you know they will tell you 1 in about 10,000 will die on the treadmill (I like those odds).  It used to be that I would always tell the people doing the test..."If I code, do not blindly intubate".  Years ago on the Men's forum, there was an EMT (paramedic) who said...If I have you and you are out...I'm intubating you blindly...You're out of it and we need that air/stomach/pouch line.  Just wondering...After many years post RNY...Does it matter if they blindly intubate?  Isn't my pouch big enough (mine has grown as big as most...Maybe bigger). and strong enough to handle it?  Do I even need to use that phrase to them?  If for some reason if I coded, they need to get that thing in me as quickly as possible...Brain cells and the heart are on the line.  Just curious...Only those in the know please respond.  Thanks, Brian  

Intubation for the for the purpose of resuscitation does not involve the stomach/esophagus in any way. The tube is placed in the airway, and if this person is truly a paramedic, I wouldn't want him anywhere near me. An NG tube or endoscope would be inserted into the stomach by a doctor, potentially in an emergency setting, and would require extra precautions, but intubation to establish an airway would not.

Intubation is not the same thing as an NG tube. Intubation means they're putting a line down into your trachea, so that they can force air into your lungs, and how they do it has no relationship to your status as an RNY patient. If you code (your heart stops), they must intubate you, and fast. While this is usually done with a laryngoscope to be able to view the placement of the tube better, it can be done without one. If you're in a hospital or other health care setting, odds are there is a laryngoscope handy on a nearby crash cart, and it will be used to place the endotracheal tube. The worry is about blindly passing an NG tube, which is short for nasogastic tube. This is a tube that goes up the nose and down the back of the throat into the stomach. It's used often for giving nutrition on a short term basis to people who aren't really conscious or have other reasons they can't eat, or also if there are reasons to aspirate (remove) the gastric juices for some reason (if there's intestinal obstruction that's being watched and allowed to clear itself, for one example.) It's recommended for RNY patients that if an NG tube is needed it's placed while using an endoscope, so as to minimize the possibility of perforating the pouch.

Personally, after researching it a bit, I don't worry much about a blind NG tube being used. The odds that it will be necessary while I'm unconscious are pretty small, and it's my feeling that healthcare professionals are generally knowledgeable enough to know how to place an NG tube without causing a perforation.

I hope this helps clarify.

What the two previous posters said.  A breathing tube, which is what they normally refer to as "intubation" is not an issue.  The only concern is a blind NG tube which, according to both a close friend who is an EMT and an acquaintance who is an ER MD, is extremely unlikely in an emergency.  The most likely reason they would put in an NG tube would be to administer charcoal for a drug overdose.

Lora

There has never been a need to worry about blind intubation.  Intubation is when they put a tube down your trachea to help you breathe.  Having RNY did not change anything about your trachea or lungs.

It's a blind NG tube, a tube that goes up the nose, down the back of the throat in the esophagus into the pouch, that can possibly cause problems.  Those are two very different things. 

If you stop breathing and need to be resucitated, you would need to be intubating, not have an NG tube.

And there is no such thing as an air/pouch/stomach line.  Air goes in one "pipe," the trachea, while another "pipe," the esophagus, goes to the pouch and stomach.

Thanks people...You are right.  Having had heart bypass I remember well the NG tube...And was so happy when it was taken out.  Again it's been about 8 years since the RNY seminar for surgery.  Looking at my Medic Alert bracelet (which I never bother to wear), they use the phrase "ROUX-EN-Y Do not blindly place nasogastric tube.  Yeah, that is different that the airway tube...

Thanks for bringing up this complicated matter.  My local hospital is currently applying to be a center for weight management..hoping this ensures the ER medical staff will be more apt to know how to properly help gastric bypass patients in our remote area.