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Left: Posterior arytenoid web developed after a 40 minute intubation
Right: After endoscopic laser therapy |
The subject of overdoses segues me to another topic of interest to the skeptical observer in the emergency department (ED) and intensive care unit (ICU). Patients with alcohol intoxication, drug overdose, and various other maladies that cause decreased level of consciousness (LOC) are often intubated (a breathing tube inserted through the vocal cords and into the trachea [airway]) so as to "protect the airway". Under normal conditions, there are powerful reflexes in the oropharynx, larynx, and trachea that cause you to gag and cough to keep everything but air out of the airway to prevent the development of an obstruction or pneumonia. Because of this, powerful sedatives and often paralytic medications have to be given to a person to enable the insertion of the tube - otherwise it will be violently rejected by these reflexes. Various conditions, chief among them drug and medication effects but including even normal sleep, can cause a depression of the intensity of these reflexes, which often arouses concern that patients with decreased LOC will aspirate (get liquid or solid material in the form of saliva, mucous, food, etc. into the airway). By intubating such patients with a tube that effectively seals off the airway (by means of a balloon that is inflated at the end of the tube), it is thought that the airway is thusly "protected".
