Straight to advanced airway on code?

[usalsfyre]

Yeah, but a BVM with 15+lmp gives ~100% o2, I fail to see how an NRB with essentially the lowest form of blowby could even come close. Not to mention when you take dead space into consideration, there is hardly any alveolar vent from compressions. Yeah, sure, it's adequate if you're solo. But when you have a surplus of hands, I'm talking optimum pt care.

Gas laws and diffusion young padawan, gas laws and diffusion...

This is why the people that told you "street smarts" were more important than "book smarts" were dead nuts wrong.

 

[WestMetroMedic]

Here is my initial disclaimer.
-i work for one of the centers pushing out research mentioned earlier. One of the principles is my medical director.
-we have the Lucas2 fully deployed in all of our trucks.
-we run with two paramedics and work with primarily full time first response agencies (police and fire)

We have our first responders place a king airway after they start compressions. After we arrive, we deal with the initial salvo of tasks to get an arrest rolling. After that has subsided, and about ten minutes have elapsed, we remove the king and intricate the patient. The Lucas2 never stops. I have run 6 or 7 codes since we changed our practice early this year, and have had excellent results. Intubating with consistent Lucas CPR is rather easy for this mediocre paramedic.

It's all about compressions, but if you can manager the airway subordinate to the compressions, why not provide the best care you can.

 

[mycrofft]

I'm just wondering if you all have any thoughts on this rather narrow series of events: Say you're on scene, pt's airway is patent and have gag, and either while transporting or on scene they code and or lose their airway. Personally I feel it is a waste of time to drop an npa/opa especially if they've just coded in front of you. I'd rather go for my advanced airway (combi/king/lma.)so we can do synchronous respirations. Unfortunately protocols differ from my opinion.

Any experiences / thoughts.

1. In a witnessed field code, immediately start compressions and defib, and get thee to a hospital.
2. If that is being taken care of, Contestant #2 (no offense) will get an IV in and airway if possible.

All these studies...I'm not seeing satisfactory statistical control for three variables: transport time/distance; control of gastric distention/regurgitation; and etiology/presenting severity/length of time down before contact.

 

[Frozennoodle]

The ONLY two interventions proven to provide any improvement in cardiac arrest are compressions and defibrillaton. NOT intubation or ventilation. Especially with the current CCR projects and research, there are good or better outcomes if intubation or advanced airway protection is deferred to later points in the resusication.

I'd argue that's due to the fact that providers are messing around trying to intubate and pausing compressions to do so. The longer you wait the more time the heart has to reestablish some perfusion. The flip side to that coin is that 30:2 is worse than continuous compressions so getting advanced airway placement also becomes a coronary profusion issue. You also have a much harder time deploying a resQpod with straight BVM ventilations further reducing cardiac efficiency. Anyways, yes prioritize and treat the etiology. Also remember one of the reasons we insert an OPA/NPA is to confirm loss of a gag reflex before performing advanced airway interventions.

 

[Frozennoodle]

Here is my initial disclaimer.
-i work for one of the centers pushing out research mentioned earlier. One of the principles is my medical director.
-we have the Lucas2 fully deployed in all of our trucks.
-we run with two paramedics and work with primarily full time first response agencies (police and fire)

We have our first responders place a king airway after they start compressions. After we arrive, we deal with the initial salvo of tasks to get an arrest rolling. After that has subsided, and about ten minutes have elapsed, we remove the king and intricate the patient. The Lucas2 never stops. I have run 6 or 7 codes since we changed our practice early this year, and have had excellent results. Intubating with consistent Lucas CPR is rather easy for this mediocre paramedic.

It's all about compressions, but if you can manager the airway subordinate to the compressions, why not provide the best care you can.

I love this.

 

[Brandon O]

Also remember one of the reasons we insert an OPA/NPA is to confirm loss of a gag reflex before performing advanced airway interventions.

I am not sure if I am on board with this approach. An OPA can induce vomiting just as much as an ET tube; I would not advise sticking it places unless you're already pretty darn sure about a gag.

 

[Frozennoodle]

I am not sure if I am on board with this approach. An OPA can induce vomiting just as much as an ET tube; I would not advise sticking it places unless you're already pretty darn sure about a gag.

I don't mean for it to come across like I'm saying its like a CBG or ETCO2 as far as diagnostic equipment goes. But if you think a pt lost a gag reflex and is otherwise unresponsive its easier to take an OPA out than a combi or king if you're wrong.

 

[Brandon O]

I don't mean for it to come across like I'm saying its like a CBG or ETCO2 as far as diagnostic equipment goes. But if you think a pt lost a gag reflex and is otherwise unresponsive its easier to take an OPA out than a combi or king if you're wrong.

Fair enough. And we've probably all stuck one in there and had to do a "whoop, never mind" when we were wrong.

 

[Akulahawk]

I'm of the opinion that I'd get going on compressions and electrical therapy in this scenario. It's a witnessed field arrest and I want to get some / keep some blood circulating before I start kicking the heart with some electricity. After a round or two, I'm going then consider getting airway equipment handy & hooked up ASAP. As to airway adjuncts, I'm going to likely use an OPA at first, then switch over to ETI as time and opportunity permits. If I have other options, I may consider using those instead of the ETI, but again, time/opportunity is a factor. I may have my partner stop the vehicle and come in the back to take over compressions while I do other things if necessary, and then resume transport.

 

[RackCityEMT]

In our system if they code en route we will pull over to have that extra set of hands and if need be we will drop a king if we have time. Normally its just an OPA or NPA and a bag.