No airway

[SeeNoMore]

I am always grateful for advice from other EMS folks but I don't worry about the harshness of criticism. In my mind it should not matter. I should be my own harshest critic. This does not mean giving up when a mistake is made. All of us have made errors or realized there was an area of our practice that could be improved. Try to be as agressive and comprehensive with your education as possible. It is far better to avoid a bad call by education than be forced into learning from your mistakes.

 

[DesertMedic66]

That's why I always carry a wet shop vacuum and a silver spoon on these types of calls.

 

[Kevinf]

I'm with Jeff on this one. EMS is taught to be afraid of suctioning. I'm sure I'm not the only one to get the "no more than 15 seconds and don't go too deep" lecture in class. And unless your patient is able to close their lips around the suction tip to create a seal, the suction units are not going to be terribly effective regardless. Any device that increases the efficacy of suctioning is welcome in my book.

 

[jwk]

Do you guys not have NG/OG tubes?

For what? (in this particular case)

 

[VFlutter]

For what? (in this particular case)

Decompress the stomach and place it on continuous suction.

 

[PFDEMT]

I'm saying that SIX failed airway attempts is piss poor patient care anyway you slice it. Do you think that cramming a combi tube in on attempt number 3 is going to deliver any different results than the first 2 failed attempts? If your answer is yes, you need retraining. (Do you think trauma from repeated CombiTube insertion attempts might have been what "packed the airway full of blood..."?)



As I said, managing a messy airway is difficult, but certainly not impossible. Did they truly AGGRESSIVELY, CONTINUOUSLY suction? I don't know, and neither do you. Can this person place an OG/NG tube? However, from the description, they seemed WAY more focused on obtaining an advanced airway than actually MANAGING the patient. An airway course, as I mentioned, would have taught some triucks like using a merconium aspirator and how to suction a misplaced tube while leaving it in place.



Did you ever hear the expression, "Blame it on the rain?" Not my fault. The equipment was didn't work. Not my fault, the airway was clogged with puke. Not my fault, the trachea was really anterior. Not my fault, the tube must have moved. Not my fault... and on and on. Guess what? It's the FAULT OF THE PROVIDER. It's our job to manage these patients. Not only the ones with a dry, Class I Mallampati... but the puke filled, difficult to ventilate patients too.



Don't be obtuse. The advise in this thread is take an airway course and own the issue. The OP couldn't manage the airway. It's plain and simple. And you know as well as I do, the agencies that provide continuing education on airway management have statistically higher first pass intubation success rates. Education is the key...

IM WITH THIS GUY!!!! ^^^^^^^^^^^^^^

 

[jwk]

I'm with Jeff on this one. EMS is taught to be afraid of suctioning. I'm sure I'm not the only one to get the "no more than 15 seconds and don't go too deep" lecture in class. And unless your patient is able to close their lips around the suction tip to create a seal, the suction units are not going to be terribly effective regardless. Any device that increases the efficacy of suctioning is welcome in my book.

??? I think that refers to suctioning an ETT, not the oropharynx.

 

[jwk]

Decompress the stomach and place it on continuous suction.

Why? (just trying to get you to think about why you're doing something - BTW I've never dropped an NG/OG during a code)

 

[Gurby]

??? I think that refers to suctioning an ETT, not the oropharynx.

OHHHHHHHHHHHHhhhhhhhhhhhhhhh! They either never specified that during my training, or I forgot about that important detail...

Why? (just trying to get you to think about why you're doing something - BTW I've never dropped an NG/OG during a code)

Because we are F terrible at mask ventilation and will likely put a bunch of air into the stomach.

 

[gotbeerz001]

OHHHHHHHHHHHHhhhhhhhhhhhhhhh! They either never specified that during my training, or I forgot about that important detail...



Because we are F terrible at mask ventilation and will likely put a bunch of air into the stomach.

So be better. [emoji16]
It's far preferable to do it right than create additional work-arounds.

 

[gotbeerz001]

??? I think that refers to suctioning an ETT, not the oropharynx.

That refers to the oropharynx using rigid suction (as well), but lets think realistically:
If you have vomitus in the oropharynx, no advanced airway and you hit the 15 second mark... Are you really going to start ventilating again and create an obstruction??

The take-away is to do it right but but don't waste any time doing it.

 

[Gurby]

So be better. [emoji16]
It's far preferable to do it right than create additional work-arounds.

How in the world do you expect an EMT-B to simply "be better"?

I just finished a week in the OR for medic clinicals, managed ~40 patients under perfectly controlled conditions with an attending anesthesiologist standing over my shoulder telling me what to do, and my airway skills are still poor. I was talking to a friend of mine who is a 2nd year anesthesia resident about it and he said even mask ventilation is an art and that he still has a lot to learn. How can you expect an EMT-basic who just learned "make a 'c' and don't squeeze too hard" in class to do a good job?

I think really the only way to improve at this is practice on real patients (or maybe cadavers if that were somehow possible? dummies just don't cut it...) and feedback from someone who knows what they're doing. Most EMTs are not going to get much of either of those things.

 

[gotbeerz001]

^^^ So find opportunities to do that. To make a blanket statement such as "we are F terrible at mask ventilations" is frustrating; we are not all "F terrible" at mask ventilations and if your skills are weak, find a way to improve them. That is what I mean by "be better".

I don't expect an EMT-B to be able to drop an NG tube, either. If you need to use a medic to get any tube, may as well be an ETT.

 

[jwk]

OHHHHHHHHHHHHhhhhhhhhhhhhhhh! They either never specified that during my training, or I forgot about that important detail...



Because we are F terrible at mask ventilation and will likely put a bunch of air into the stomach.

So then you're going to try and mask someone with an NG/OG in the way and messing up your seal?

 

[Gurby]

So then you're going to try and mask someone with an NG/OG in the way and messing up your seal?

Well it sounded good on paper anyways... Maybe the answer truly is just "be better"...

 

[gotbeerz001]

We can always "be better". [emoji16]

 

[Carlos Danger]

How in the world do you expect an EMT-B to simply "be better"?

I just finished a week in the OR for medic clinicals, managed ~40 patients under perfectly controlled conditions with an attending anesthesiologist standing over my shoulder telling me what to do, and my airway skills are still poor. I was talking to a friend of mine who is a 2nd year anesthesia resident about it and he said even mask ventilation is an art and that he still has a lot to learn. How can you expect an EMT-basic who just learned "make a 'c' and don't squeeze too hard" in class to do a good job?

I think really the only way to improve at this is practice on real patients (or maybe cadavers if that were somehow possible? dummies just don't cut it...) and feedback from someone who knows what they're doing. Most EMTs are not going to get much of either of those things.

I completely agree with this.

Airway management is a skill that takes practice and experience that most of us just don't get enough of in school or after.

We do need to seek opportunities to improve our skills, of course. But as hard as one tries, those opportunities can be really hard to come across. Asking about techniques and tricks ("work arounds", I guess) that might make it easier is entirely legit.

I don't agree that OG tubes are the answer in most cases - nor is stuffing as many airways adjuncts as we can fit, as was asked in the another thread on a similar topic.

But they are both perfectly reasonable questions. Talking about this stuff is part of the process of getting better.