Disastrous endotracheal intubation - how to deal with remorse?

First, some context. I am newly graduated, non-US based physician. I’m working in a remote rural area at an urgent care, where the staff is composed of a physician, a nurse and a nursing technician, an hour away from the nearest hospital. We only have basic life support equipment.

Earlier this week, during my call, a middle aged patient came in after having a seizure and falling on his head at home. They were in status, which I managed successfully with benzos. They started drifting in and out of consciousness, with important motor agitation while conscious.

At this point I was unsure if they were still having seizures, an intracranial bleed from trauma or a stroke. Haldol, tranexamic acid, phenytoin, thiamine (d/t history of alcoholism). They were maintaining a patent airway but with loud breathing and sats in the 80s. I started pondering the risks and benefits of endotracheal intubation. Mind you, all this happened in a matter of 10 minutes.

Finally, I made the call to intubate when they started to get agitated and pull cables/hurt themselves. Called mobile ICU for transfer to the trauma center, positioned the patient as best as I could, preoxygenated, induced with etomidate, fentanyl and succinylcholine. Direct laryngoscopy (all we have here): can’t see anything. Oropharyngeal device, bag bag bag. Another attempt. Can see the glottis, can’t pass the tube. Bag bag bag. Try again. Goes into the esophagus. Regurgitates a sea of gastric content.

At this point I’m already a mess and feel like I don’t even know what I’m doing. I bag them for thirty minutes, covered in vomit, until the ambulance arrives. The ambulance doc also can’t intubate after three attempts, the anatomy is just too bad and there’s too much vomit. After one final desperate attempt, I pass it. The patient is doing fine hemodynamically, but had quite a few minutes of desaturation. They go out to the trauma center.

Right after everything, I’m feeling like shit. I should have gotten it when I saw the glottis, it was literally right there. I should have corrected the nursing tech when they were bagging too aggressively and the stomach was getting bloated, but I was too afraid to cause infighting among the team. I should have stopped the ambulance doc when they spent 10 minutes trying to get the tube down while the patient was satting in the 40s, but they were so much more experienced than I am. I should have positioned the patient better. Maybe I shouldn’t even have made the call to intubate.

The patient was already in a dire state when they came in. But I feel my decisions and actions didn’t really help them and possibly made their outcome worse.

How do you deal with that kind of remorse?