There you were, minding your own business when EMS brings you a sick-as-can-be patient, intubated in the field for who knows what. Someone gets overzealous with their trauma shears and cuts off the pilot balloon on the endotracheal tube.

This happened to me twice in my PGY2 year.

Obviously, this ETT will need to be exchanged, but what is your strategy for temporizing the patient that really was on the edge of life and death, needing every last mL of tidal volume, every cmH2O of PEEP?

To buy yourself all the time in the world, you need three items, all readily available in your average emergency department:

  1. 20 gauge angiocath
  2. Three way stopcock
  3. 10 mL syringe

A 20 gauge angiocath will fit perfectly in the balloon tubing of any standard ETT, regardless of the ETT diameter. If you attach a three way stopcock to this, you have just bought yourself the ability to reinflate the cuff, reoxygenate the patient, and all the time you need to safely exchange the tube.

If you don’t have a three way stopcock at hand, you can use the 20 gauge angiocath to inflate, and then use a pair of Kellys or locking needle drivers from a suture kit to pinch off the tubing and hold the seal.

I’ve used this. It works. Keep it in your mental back pocket.

June 2024