Intubations can be difficult for numerous reasons, but in my mind the most frustrating circumstances is when you have the trachea cannulated (either by open tracheostomy or perc trach) and are unable to pass the endotracheal tube. This occurred to me on a recent patient.

Case Description

The patient was a 69-year-old woman nursing home resident who was admitted to the ICU with right lower lobe pneumonia and early sepsis. On admission she h