# NREMT skills sheet question



## Chief Complaint (Apr 11, 2011)

Just going over my skills sheets for registry at the end of May and i found something that just doesnt make sense to me.

After ET intubation, the examiner will state that "you see secretions in the tube and hear gurgling sounds with the patient's exhalation".

It is a *critical criteria* to pre-oxygenate the patient PRIOR to suctioning the tube with a soft catheter.  Wouldnt that cause the patient to aspirate the fluids?  Wouldnt suctioning for a few seconds and then resuming ventilations make more sense?


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## 8jimi8 (Apr 11, 2011)

Chief Complaint said:


> Just going over my skills sheets for registry at the end of May and i found something that just doesnt make sense to me.
> 
> After ET intubation, the examiner will state that "you see secretions in the tube and hear gurgling sounds with the patient's exhalation".
> 
> It is a *critical criteria* to pre-oxygenate the patient PRIOR to suctioning the tube with a soft catheter.  Wouldnt that cause the patient to aspirate the fluids?  Wouldnt suctioning for a few seconds and then resuming ventilations make more sense?



You will be removing their oxygen from their lungs.  When you bag a patient, you don't just squeeze it in there at 500mph.   You bag gently and watch for ADEQUATE chest rise.  Before you do anything with an advanced airway for national registry, you'd best just remember to preoxygenate.  Miss your tube on fred the head? "i direct my partner to preoxygenate the patient"  just as important as scene safety and BSI.


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## Chief Complaint (Apr 11, 2011)

Im not sure that im following what you are saying.  

By pre-oxygenating a patient with secretions in the tube, arent i just forcing those secretions into the lungs?  Why wouldnt i suction for <10 seconds and then resume ventilations?  Clearly they will be deprived of oxygen during suction but isnt that better than forcing fluids into their lungs?


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## johnrsemt (Apr 12, 2011)

When you are hearing and seeing fluid in the tube; it is ALREADY in the lungs (unless the tube is in the esophagus {sp?}).  So oxygenating isn't going to put more fluid into the lungs,  and the patient needs the oxygen.


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## Shishkabob (Apr 12, 2011)

NREMT =/= real life.


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## HotelCo (Apr 12, 2011)

Linuss said:


> NREMT =/= real life.



+1000

There's the registry way, and the real way. Every so often they'll overlap.


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## Chief Complaint (Apr 12, 2011)

Thanks for all of the replies!  Makes sense now.


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