A car of what appear to be college aged students pulls up in front of the ER just as I’m walking past the entry way. A tech rushes in to grab a stretcher and I follow it out to the car. I see two strapping young men pull their buddy out of the car by his shoulders and knees, completely limp. We get him to the trauma bay, start assisting ventilations and I intubate him…on my 2nd attempt.

The first attempt was with a tube that was too big…bigger than what I asked for. That really aggrevated me, since we had already paralyzed him! The good news was that we were easily able to bag him. I had great visualization of the cords but when I put the tube in, it just wouldn’t pass. I called for a 7.0, assuming I had just tried with the 7.5 which is what I asked for. I glanced down and saw it was an 8.0 and steam started rising from my ears. I had tried to be very directive with each person, specifically asking my NURSE for meds, my COM TECH to hold cricoid pressure & squeeze the bag with one hand and my MEDIC to hold the mask to his face with 2 hands while simultaneously doing a jaw thrust. It all seemed to be working great, until my DEPARTMENT CHAIRMAN hands me a tube that is one size too big. It is difficult to argue with his experience, but I am learning to trust my instincts more and more due to events like this.