# Oral Screw



## WiFi_Cowgirl (Jan 20, 2009)

Anyone every have to use one of these? I've accidentally broken someones false teeth, because I couldn't pry their jaw open to insert an OPA.


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## BLSBoy (Jan 20, 2009)

This thread's title is completely misleading.


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## Sasha (Jan 20, 2009)

BLSBoy said:


> This thread's title is completely misleading.



I know! I was like WOW!!! Paging FFEMT! Paging FFEMT!


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## EMTinNEPA (Jan 20, 2009)

BLSBoy said:


> This thread's title is completely misleading.



Good to see I'm not alone lmao


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## Sasha (Jan 20, 2009)

WiFi_Cowgirl said:


> Anyone every have to use one of these? I've accidentally broken someones false teeth, because I couldn't pry their jaw open to insert an OPA.



Why, if you couldn't get their jaw open, did you not go for the NPA? 

Isn't that a sign of rigor, anyway?


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## rmellish (Jan 20, 2009)

Sasha said:


> Isn't that a sign of rigor, anyway?



Sometimes, but its also a common sign of hypoxia.

Haven't seen one of those on a truck...just in the back of the supply room. 

NP is the way to go, or a nasal intubation if you have a medic handy.


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## rmellish (Jan 20, 2009)

BLSBoy said:


> This thread's title is completely misleading.



Absolutely, there's no way I couldn't click on it


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## BLSBoy (Jan 20, 2009)

Sasha said:


> Why, if you couldn't get their jaw open, did you not go for the NPA?
> 
> Isn't that a sign of rigor, anyway?



Not always. Seizure pts will clench, and I have seen Etomidate do it when we had to MFI a guy.


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## rmellish (Jan 20, 2009)

BLSBoy said:


> Not always. Seizure pts will clench, and I have seen Etomidate do it when we had to MFI a guy.



Yeah, seizures too...forgot about that.


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## marineman (Jan 20, 2009)

rmellish said:


> NP is the way to go, or a nasal intubation if you have a medic handy.



I can go with an NP but for nasal intubation you still have to get your hand in their mouth.

At any rate I concur with the masses about the title and no we don't carry them.


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## reaper (Jan 20, 2009)

marineman said:


> I can go with an NP but for nasal intubation you still have to get your hand in their mouth.
> 
> At any rate I concur with the masses about the title and no we don't carry them.



Why do you need your hands in their mouth?


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## WiFi_Cowgirl (Jan 20, 2009)

It was a seizure when we arrived, upon it ceasing, it became a cardiopulmonary arrest. Likely, a clot, lack of blood to the brain triggered the seizure and respiratory arrest; and finally cardiac arrest. He died.. After I had the OPA in for a few minutes, we were able to get his dentures out and he was intubated.

Misleading title, not really.. Because the product is called the Jaw Screw and you can find it by Googling. The title.


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## marineman (Jan 20, 2009)

reaper said:


> Why do you need your hands in their mouth?



Guide the tube from where it comes out of the nasal passage into the trachea. Unless there's some special trick to make it magically fall in the proper hole that they didn't teach us in school.


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## ffemt8978 (Jan 20, 2009)

BLSBoy said:


> This thread's title is completely misleading.



Yep...got me to look in a big hurry...


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## reaper (Jan 20, 2009)

Nasal tubes will have a wire attached that lifts the end of the tube, when pulled. You throw a BAM on it and guide with the inspiration.

I have done hundreds and never had to guide through the mouth.


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## JPINFV (Jan 20, 2009)

I just did a google image search for "oral screw" and did not leave disappointed.


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## marineman (Jan 20, 2009)

I don't think we carry different tubes for nasal intubation. I'm not positive but I'd assume we are allowed to do it. In class we always used a standard ETT for nasal.

Edit: reaper do you have a pic handy of those nasal tubes? Never seen one but would like to see if I can wrap my head around what they are a little more.


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## reaper (Jan 20, 2009)

marineman said:


> I don't think we carry different tubes for nasal intubation. I'm not positive but I'd assume we are allowed to do it. In class we always used a standard ETT for nasal.
> 
> Edit: reaper do you have a pic handy of those nasal tubes? Never seen one but would like to see if I can wrap my head around what they are a little more.



These are the tubes we use, http://www.nellcor.com/prod/Product.aspx?S1=AIR&S2=&id=133

I have used ETI tubes without a problem.


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## VentMedic (Jan 20, 2009)

reaper said:


> These are the tubes we use, http://www.nellcor.com/prod/Product.aspx?S1=AIR&S2=&id=133
> 
> I have used ETI tubes without a problem.


 
The Endotrol is expensive at about $11.50/tube vs $2.00 per regular ETT.

Quote from OP


> I've accidentally broken someones false teeth, because I couldn't pry their jaw open to insert an OPA.


If the patient aspirates the teeth, that may hamper the resuscitative efforts a little also. If the pt lives, the retrieval of the broken teeth may lead to more complications and possibly death.


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## medic417 (Jan 20, 2009)

JPINFV said:


> I just did a google image search for "oral screw" and did not leave disappointed.



I think if I searched that at work would get fired.


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## Ridryder911 (Jan 20, 2009)

They are no longer used. When I first started out they were as popular as an oral-pharyngeal airway (also bite blocks). The problem is they will pop out teeth and tear muscles. 

Fortunately, we have became more educated and realize to stop the activity to be able to open the mouth per pharmacological agents and or treat the cause. 

R/r 911


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## vquintessence (Jan 20, 2009)

marineman said:


> I don't think we carry different tubes for nasal intubation. I'm not positive but I'd assume we are allowed to do it. In class we always used a standard ETT for nasal.



Check out:
http://www.youtube.com/watch?v=HXjPdNSL96c
It was posted by someone on this forum a year+ ago.  In it you'll see the whistler (BAAM).

For your service which is probably like mine, we don't have much more than a scope and colormetric, let alone capnography or BAAM.  Did they show you the trick to roll up the ETT?  If not:

Roll the ETT into a complete ring.  Try to keep the shape as you advance it down the nare (keep in mind you will have to aim slightly toward midline), once you guesstimate that it's getting deep enough and in the general area of the cords, start to listen for respirations/coughing _through_ the tube.  Ya should be able to freely keep advancing (and continuing to hear sounds) until ya get deep enough with the tube, inflate and hopefully you've got some good anatomy and otherwise luck +finesse on your side.  Just an option when ya don't have the equipment or other alternatives.


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## marineman (Jan 20, 2009)

The department I'm doing my rides with has surgical cric in their protocols so they might jump straight to that if they can't do a standard ETT but I'll have to look into it. Thanks for the pointers either way.


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## Ridryder911 (Jan 20, 2009)

I have performed hundreds of nasal intubations and never have opened their mouth. Why nasally intubate if I can do it orally? 

Manipulation of the head and on a breathing patient feeling the "pop" as it goes through the glottic opening. An old trick I have learned in ambient noise areas is to take the bell off a cheap stethoscope and place the tube slightly into the ETT. You will hear the breathing much more clear and can introduce the tube upon inspiration.  * Sorry Vent I know its not sterile..

The other technique is the digital intubation technique which I have done a few times but that is a totally different story.. if you are able to check out the Old archives, I wrote an article on special techniques of intubation many decades ago for _JEMS._

R/r 911


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## HotelCo (Jan 20, 2009)

I was expecting something very different when I clicked on this link.


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## marineman (Jan 20, 2009)

Ridryder911 said:


> The other technique is the digital intubation technique which I have done a few times but that is a totally different story.. if you are able to check out the Old archives, I wrote an article on special techniques of intubation many decades ago for _JEMS._
> 
> R/r 911



Digital is my specialty in class anyway, doesn't seem like something I'd ever want to try on a real patient. God has gifted me with very long very skinny fingers that work very well for digital intubation.


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## Sasha (Jan 20, 2009)

> God has gifted me with very long very skinny fingers that work very well for digital intubation.



I never got one on a dummy, and I'll probably never get an oral intubation on a live person either. God has cursed me with short, fat fingers that could not reach far enough :]


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## reaper (Jan 21, 2009)

VentMedic said:


> The Endotrol is expensive at about $11.50/tube vs $2.00 per regular ETT.
> 
> .



Yes, They do cost more, but do increase intubations on the first try. You may only do one nasal a month, so the cost is not to bad.

I use regular ETT for nasal too. It is just a little easier with the nasal tube.


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## Sasha (Jan 21, 2009)

Wow, duh. Change oral to digital in my last post.


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## eggshen (Jan 21, 2009)

Yea, trigger tube does not = nasal tube. No need for a BAAM, but get in where you fit in. If it helps, use it. Used to BNTI _A LOT_ (notice "a lot" is not one word), CPAP has changed that practice a bit. Speaking of changing practice? That screw is dope!!! I have not seen those in forever. I remember way way back my gym teacher even had one on his keychain. It was OK to hit kids with a plywood board then too though. It was a beautiful piece of wood. What kind of sick f**k puts that kind of work into a board for hitting kids?

Egg


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## fortsmithman (Jan 21, 2009)

BLSBoy said:


> This thread's title is completely misleading.


When I saw the header I thought wow.  Its extremely misleading.


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## rmellish (Jan 21, 2009)

marineman said:


> I can go with an NP but for nasal intubation you still have to get your hand in their mouth.



Really? I've certainly never done it, but I thought it was a blind attempt through the nose...


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## Jon (Jan 21, 2009)

Ridryder911 said:


> They are no longer used. When I first started out they were as popular as an oral-pharyngeal airway (also bite blocks). The problem is they will pop out teeth and tear muscles.
> 
> Fortunately, we have became more educated and realize to stop the activity to be able to open the mouth per pharmacological agents and or treat the cause.
> 
> R/r 911


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