# BLS and Combitube



## sirengirl

So recently I was sitting at my volunteer BLS station talking to another EMT. I'll mention early on that I'm the youngest EMT and the youngest volunteer at the station, as the city it's in is a small, predominantly elderly city, and it's not unusual for people at the station to be old enough to be my grandparents, and so to treat me condescendingly. I'm used to it. This particular EMT-B was having a discussion with me about "what would you do if..." which is how we wear away the time waiting for someone to slip and fall at a nursing home or something. Our discussion at the time was about Combitubes. He was asking when I would decide to insert one versus use a BVM. The county that we are in is ALS Fire/Medic and we're the only BLS unit around; the city is also about five square miles and very small. Our station is half a mile from the closest fire station.

"Well," I told him, "I'd consider a combitube if they're unresponsive, cardiac, and ALS is more than 10 mins ETA, because that's long enough to get a few rounds of CPR in and a shock or two if indicated."

He begins to argue with me about _how do you know how far away they are_ because apparently he thinks calling and asking for an ETA is a hard thing. Ever since, I've been wondering what others would do. Of course I could bag someone until the cows came home if I so desired, so in all technicalities unless our rescue is coming from the next town up (a 20 minute Interstate drive), I probably wouldn't consider a combitube unless they're getting hypoxic in front of me. I was wondering what others think, from a BLS standpoint?


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## TransportJockey

When I work a code here... CPR is first priority. Then I'll toss a combitube even if my medic is walking through the door. An airway is an airway, and in a code, fast and not interrupting chest compressions is goal 1. 
After combi, I start looking for lines, usually staying at the head after placing the combi and sticking an EJ


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## sirengirl

Exactly. I'm more concerned with doing adequate compressions than I am about monkeying around with a fancier airway (assuming that I am having no complications with a BVM OPA/NPA) when I know the medics are going to rip it out when they get there and intubate. I've never had an occasion thusfar that, should it have been a code, I was on scene long enough to be able to get in a full round of compressions before ALS arrival. They usually pull up within 2 minutes.


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## TransportJockey

I work an ILS truck (as sr on truck) in a rural county. We usually have maybe 2 medics on duty in county at any given time. If I have a combi in place when they arrive, they usually go with that and don't yank it to intubate. If you have a medic that will pull a perfectly patent rescue airway just so they can drop an ETT in a code, they need to be kicked down a notch or two and told to leave their ego at the door. With the new guidelines, compressions are so much more important than airway.


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## sirengirl

I won't say much about the medics I've worked with from that particular station other than that, there are a few who could stand to work on their people skills and their egos. I've never had an opportunity to see them do more than a 12-lead. I'm sure they do great work, but what exactly, remains to be seen... In any case my initial question was whether you would bother with a combi if you know ALS is within 10 minutes and you have a patent airway with OPA/NPA.


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## TransportJockey

Sorry, didn't mean to pull it off topic. But yea, my answer would be yes in codes. Other circumstances would be maybe


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## abckidsmom

sirengirl said:


> Exactly. I'm more concerned with doing adequate compressions than I am about monkeying around with a fancier airway (assuming that I am having no complications with a BVM OPA/NPA) when I know the medics are going to rip it out when they get there and intubate. I've never had an occasion thusfar that, should it have been a code, I was on scene long enough to be able to get in a full round of compressions before ALS arrival. They usually pull up within 2 minutes.





TransportJockey said:


> I work an ILS truck (as sr on truck) in a rural county. We usually have maybe 2 medics on duty in county at any given time. If I have a combi in place when they arrive, they usually go with that and don't yank it to intubate. If you have a medic that will pull a perfectly patent rescue airway just so they can drop an ETT in a code, they need to be kicked down a notch or two and told to leave their ego at the door. With the new guidelines, compressions are so much more important than airway.



Absolutely.  I think that universally, a good medic will not pull a functional combitube in order to intubate.  That assumes good lung sounds, expected EtCO2 waveform (flat if dead), and good compliance.

Pulling a combitube invites laryngeal edema to take over and block whatever airway you had left.  I saw a few CBT switchovers to ETTs while I worked in an ICU, and it was always a well-choreographed routine, not just a simple pull the tube and intubate kind of deal.

You're on the right track.  Keep it up.  And it's super easy to get an ETA from incoming units.  "What's your ETA?"  "12 minutes."  Done.  The most complicated part might be if they state their location instead of a time.  Then you have to think a little.  Oh, well.


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## abckidsmom

sirengirl said:


> I won't say much about the medics I've worked with from that particular station other than that, there are a few who could stand to work on their people skills and their egos. I've never had an opportunity to see them do more than a 12-lead. I'm sure they do great work, but what exactly, remains to be seen... In any case my initial question was whether you would bother with a combi if you know ALS is within 10 minutes and you have a patent airway with OPA/NPA.



Sorry, I hijacked, too.

Patent airway with OPA/NPA?  That depends on how much air is getting into their stomach, and how long it's going to be until they puke.  It's tough I know, but it's case-by-case.  Cardiac arrest?  Don't interrupt CPR, go ahead and drop the CBT.  Unconscious?  Wait a bit, figure out why the patient's unconscious.  Unconscious diabetic?  Probably not.  Seizure?  Probably not.  Other etiologies will vary.

If you are NOT putting in a CBT and are waiting on scene for ALS, you definitely MUST have portable suction out and ready, even ON, waiting for the emesis.


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## sirengirl

abckidsmom said:


> And it's super easy to get an ETA from incoming units.  "What's your ETA?"  "12 minutes."  Done.  The most complicated part might be if they state their location instead of a time.  Then you have to think a little.  Oh, well.



Yeah the guy I was talking to was making it sound as though it was an ordeal to have to contact dispatch (ours is separate) and ask them to have the responding unit tell their ETA and then let me know...


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## sirengirl

abckidsmom said:


> It's tough I know, but it's case-by-case.



THIS. I live by this rule. When I was still precepting onto the squad I worked with an EMT who, whenever we got a call, wanted me to get out of the truck, stop in front of her before entering the building, and verbalize a complete list of exactly what I was going to do and what I thought about the call before ever seeing the patient. The end of that day couldn't come fast enough....


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## Smash

abckidsmom said:


> Absolutely.  I think that universally, a good medic will not pull a functional combitube in order to intubate.  That assumes good lung sounds, expected EtCO2 waveform (flat if dead), and good compliance.



Sorry, another hijack. EtCO2 waveform will not be flat unless you are trying to resuscitate a corpse. If it is an actual, viable arrest and good quality CPR is being performed then you will have a waveform.  The actual etco2 itself may be low, but the waveform will still be there.  
If you don't have a waveform, something is wrong that needs fixed, like rube in wrong hole, obstructed tube, that sort of thing.


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## marcus2011

If adequate ventilation is being done with a combi or a king with bilateral chest rise then by all means leave the BIAD in place. Taking the time to remove the tube when the medics get there to drop a ET tube could be used in better things like getting an iv set up, switching monitors if yours does not have a Manuel shock or other things like that


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## abckidsmom

Smash said:


> Sorry, another hijack. EtCO2 waveform will not be flat unless you are trying to resuscitate a corpse. If it is an actual, viable arrest and good quality CPR is being performed then you will have a waveform.  The actual etco2 itself may be low, but the waveform will still be there.
> If you don't have a waveform, something is wrong that needs fixed, like rube in wrong hole, obstructed tube, that sort of thing.



You're right.  I misspoke.  I was picturing a very flat, low waveform.  I know waht you're talking about.  Thanks for clarifying my words.


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## flyfisher151

Good thread! Got my mind turning. I see why no on seizures and diabetic emergencies. BTW?? Do you check BGL on an unconscious person to determine diabetic emergency??? I'm a humble student and yes I am asking this question for real trying to learn. Or do you try to obtain this info from a famliy member during your SAMPLE history? Bracelet/Necklace? Thanks in advance. I figure admitting you know nothing will help facilitate the learning process!


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## Anjel

Ok....what I would do lol

If it is an arrest. and I am going to be transporting by myself...then they are getting a combitube. Im not gonna mess around trying to get a seal with a mask. 

I can place the tube in less than 30 seconds. Once its ready. So not a problem.

However... If medics are gonna be there in less than 10 minutes. And I have someone helping me with cpr then no I probably wouldn't use it. 

So.... 2 person cpr medics coming....probably not

By myself...heck yea I am. Ill have a cop or ff open the package and fill my syringes or do what I gotta do while they do compressions ( if they are trained to and can)


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## babygirl2882

In my dept 99.9% there will be ALS on scene, we rarely rarely just have a BLS crew, but I know of at least one medic that if he can't get an ETT will let me put in a combi. 


Not to hijack the thread but, anyone out there use the king airway?


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## rwik123

flyfisher151 said:


> Good thread! Got my mind turning. I see why no on seizures and diabetic emergencies. BTW?? Do you check BGL on an unconscious person to determine diabetic emergency??? I'm a humble student and yes I am asking this question for real trying to learn. Or do you try to obtain this info from a famliy member during your SAMPLE history? Bracelet/Necklace? Thanks in advance. I figure admitting you know nothing will help facilitate the learning process!



Arrest? Not checking the BGL obv

Unconscious... If it's within your scope (some basics can and can't check BGL). Youd find out from family members also. BUT as a basic there's no intervention you can do to combat a diabetic emergency if there unconscious. Remember for glucose the patient has to be conscious and able to take the glucose with a patent airway.


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## bigbaldguy

rwik123 said:


> . Remember for glucose the patient has to be conscious and able to take the glucose with a patent airway.



I can think of one way a basic could administer glucose without a patent airway but I have to admit I feel kind of icky even thinking about it <_<


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## rwik123

bigbaldguy said:


> I can think of one way a basic could administer glucose without a patent airway but I have to admit I feel kind of icky even thinking about it <_<



New protocol! Genius. It'll be a whole new thing, basics pushing meds up people's butts.


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## bigbaldguy

rwik123 said:


> New protocol! Genius. It'll be a whole new thing, basics pushing meds up people's butts.



"hmmmm that pill is kinda big I don't think I'll be able to swallow it" 

"oh not to worry it's not going in that end"


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## DesertMedic66

abckidsmom said:


> Absolutely.  I think that universally, a good medic will not pull a functional combitube in order to intubate.  That assumes good lung sounds, expected EtCO2 waveform (flat if dead), and good compliance.
> 
> Pulling a combitube invites laryngeal edema to take over and block whatever airway you had left.  I saw a few CBT switchovers to ETTs while I worked in an ICU, and it was always a well-choreographed routine, not just a simple pull the tube and intubate kind of deal.
> 
> You're on the right track.  Keep it up.  And it's super easy to get an ETA from incoming units.  "What's your ETA?"  "12 minutes."  Done.  The most complicated part might be if they state their location instead of a time.  Then you have to think a little.  Oh, well.



Our protocols say that once a combitube is placed it will not be removed. We only use combitubes if the medic is unable to intubate. So if a combitube is already in place when the medic gets there it will not be removed.


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## 8jimi8

sirengirl said:


> So recently I was sitting at my volunteer BLS station talking to another EMT. I'll mention early on that I'm the youngest EMT and the youngest volunteer at the station, as the city it's in is a small, predominantly elderly city, and it's not unusual for people at the station to be old enough to be my grandparents, and so to treat me condescendingly. I'm used to it. This particular EMT-B was having a discussion with me about "what would you do if..." which is how we wear away the time waiting for someone to slip and fall at a nursing home or something. Our discussion at the time was about Combitubes. He was asking when I would decide to insert one versus use a BVM. The county that we are in is ALS Fire/Medic and we're the only BLS unit around; the city is also about five square miles and very small. Our station is half a mile from the closest fire station.
> 
> "Well," I told him, "I'd consider a combitube if they're unresponsive, cardiac, and ALS is more than 10 mins ETA, because that's long enough to get a few rounds of CPR in and a shock or two if indicated."
> 
> He begins to argue with me about _how do you know how far away they are_ because apparently he thinks calling and asking for an ETA is a hard thing. Ever since, I've been wondering what others would do. Of course I could bag someone until the cows came home if I so desired, so in all technicalities unless our rescue is coming from the next town up (a 20 minute Interstate drive), I probably wouldn't consider a combitube unless they're getting hypoxic in front of me. I was wondering what others think, from a BLS standpoint?




Consider a combitube / rescue airway / supraglottic airway device after prolonged bvm ventilations/ poor quality bvm compliance.

gently bagging /c excellent technique and optimal patient positioning will carry you a very long way without accidently traumatizing the trachea in the worst case scenario of orotracheal placement of combitube.


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## sirengirl

Anjel1030 said:


> However... If medics are gonna be there in less than 10 minutes. And I have someone helping me with cpr then no I probably wouldn't use it.


^^This is my choice exactly, IF this vv is the case.


8jimi8 said:


> gently bagging /c excellent technique and optimal patient positioning will carry you a very long way without accidently traumatizing the trachea in the worst case scenario of orotracheal placement of combitube.



As it's been said on here before by another, it's always case-by-case, but if I am getting good chestrise/bilat breath sounds and pink skintone from bvm and ALS is < 10mins, I see no reason to use a combi. Just another gray area of EMS


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## Chimpie

sirengirl said:


> Just another gray area of EMS



As long as that gray matter isn't brains...


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## sirengirl

Chimpie said:


> As long as that gray matter isn't brains...



This!
There should be an option to +1 people's posts...


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## usalsfyre

babygirl2882 said:


> Not to hijack the thread but, anyone out there use the king airway?



First line cardiac arrest treatment here. We have the option of pulling the King and placing a ETT if we feel it's warranted. Can't say I feel that it often is, The King does a superb of managing 95% of airways in arrest, and it does it more quickly with no need (or temptation) to interrupt compressions to place it. Typically, if first responders or bystanders are available I'll have them continue compressions, my Basic partner place a King while I establish an IO and then continue the code. 

While an ETT is preferred in most cases, the relegation of alternative airways to "back up only" status is a lack of foresight and old medicine in most cases. There's times when placing an ETT is not practical. If you want to see an example of preemptive use of alternative airways look up Dr. Darren Braude's Rapid Sequence Airway.


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## flyfisher151

Thanks!


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## usafmedic45

> New protocol! Genius. It'll be a whole new thing, basics pushing meds up people's butts.



It's not new at all and for glucose at least, there's a fair amount of evidence that it's not all that an effective route.


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## feldy

flyfisher151 said:


> Good thread! Got my mind turning. I see why no on seizures and diabetic emergencies. BTW?? Do you check BGL on an unconscious person to determine diabetic emergency??? I'm a humble student and yes I am asking this question for real trying to learn. Or do you try to obtain this info from a famliy member during your SAMPLE history? Bracelet/Necklace? Thanks in advance. I figure admitting you know nothing will help facilitate the learning process!



unconscious person...yes. Code...if only BLS is on scene awaiting ALS then check it as long as CPR is not interrupted. If ALS gets on scene then while they are starting to push their meds then check it to see if any other hypo/hyperglycemic meds are necessary.


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## Shishkabob

How far away help is hardly ever changes what I do... if it needs to be done it gets done.  If you need an advanced airway, get one in, even if the Paramedics are walking in the door as you're pulling it out of the packaging.



My EMT and I have talked about our plans for codes, and have a system worked out.  If we get an arrest and someone is doing CPR, his first job is to insert a King, while I do other ALS stuff.  If he can't get the King, or something precludes its use, that's when I go for the ETT.  In the past 5 arrests we've had, I've only had to intubate once, and that's because he couldn't get the King past the giant tongue.


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## Shishkabob

rwik123 said:


> Arrest? Not checking the BGL obv



Why aren't you checking BGL on an arrest?


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## rwik123

Linuss said:


> Why aren't you checking BGL on an arrest?



It's just not something I see around me at least at the BLS level. If I were ALS and was starting a line and already had blood, why not. It's pretty low on the importance scale in my opinion. How many arrests have you seen that have been the result of a glycemic emergency? Maybe its something I should be doing.


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## usalsfyre

rwik123 said:


> How many arrests have you seen that have been the result of a glycemic emergency? Maybe its something I should be doing.


Not very many but it does happen and is an easily reversible cause. If nothing else you should be checking so that once paramedics arrive they can provide the correct treatment.


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## feldy

even as a basic...i see checking BGL as part of gather vitals. s/s of a glycemic emergency are similar to so many medical/ traumatic emergencies that it is something that you would want to rule out.

Since i tend to work nights i get a lot of ETOH pts so that is also my justification for obtaining BGL to make sure they are indeed ETOH and not low or high


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## rwik123

feldy said:


> even as a basic...i see checking BGL as part of gather vitals. s/s of a glycemic emergency are similar to so many medical/ traumatic emergencies that it is something that you would want to rule out.
> 
> Since i tend to work nights i get a lot of ETOH pts so that is also my justification for obtaining BGL to make sure they are indeed ETOH and not low or high



Yeah totally a vital. Im just saying it's not high up on my priorities if working a code. But if time allows, I'll be sure to do it from now on.


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## Shishkabob

Honestly as a basic on an arrest, there's only so much you can do in the first place.  If someone is bagging and someone is doing compressions... all the major BLS things are out of the way and taken care of.

Heck, even the person who's bagging has time to check a BGL in between breaths (if you're doing the AHAs 30:2)


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## feldy

Linuss said:


> Honestly as a basic on an arrest, there's only so much you can do in the first place.  If someone is bagging and someone is doing compressions... all the major BLS things are out of the way and taken care of.
> 
> Heck, even the person who's bagging has time to check a BGL in between breaths (if you're doing the AHAs 30:2)



unless you are using a resQpod or other similar device


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## usalsfyre

feldy said:


> unless you are using a resQpod or other similar device



ResQPod's science is starting to look suspect anyway....


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## Smash

usalsfyre said:


> ResQPod's science is starting to look suspect anyway....



What's that? An expensive piece of plastic pushed on services by a manufacturer may not be all it cracked up to be?  Say it ain't so!! 


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## DesertMedic66

Linuss said:


> Honestly as a basic on an arrest, there's only so much you can do in the first place.  If someone is bagging and someone is doing compressions... all the major BLS things are out of the way and taken care of.
> 
> Heck, even the person who's bagging has time to check a BGL in between breaths (if you're doing the AHAs 30:2)



Can't check BGL (in my county). Our BLS rigs don't carry the meter because it's not in our scope <_<


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## jjesusfreak01

Smash said:


> What's that? An expensive piece of plastic pushed on services by a manufacturer may not be all it cracked up to be?  Say it ain't so!! 



We use them religiously around here, but we don't turn on the pacing light, and per instructions they come off the second the pt gets pulses back. I'm not going to worry about the science behind them. I'm sure if it starts to look like they aren't helpful, our medical director will chuck them quicker than you can blink.


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## Handsome Robb

rwik123 said:


> Arrest? Not checking the BGL obv



Why not? Hypo/hyperglycemia is one of the H's and T's of ACLS and an easily reversible cause of an arrest...

We use King's not combi's, both do their job though.


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## IAems

firefite said:


> Can't check BGL (in my county). Our BLS rigs don't carry the meter because it's not in our scope <_<



Sorry to hijack this thread again, but glucose readings are _out_ of our scope too, so I carry my personal glucometer around; that way, in the event a certified _paramedic_ or even _lay person_ should want to check it, there will be one readily available. . . I mean the repercussions of a trained medical provider haphazardly monitoring a BGL could be disastrous.  Here's a line I heard once, "Not that I checked because it would be beyond my scope, but _somebody_ reported the BGL @ _around _ 652 mg/dL three minutes ago."


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## SnaKiZe

IAems said:


> Sorry to hijack this thread again, but glucose readings are _out_ of our scope too, so I carry my personal glucometer around; that way, in the event a certified _paramedic_ or even _lay person_ should want to check it, there will be one readily available. . . I mean the repercussions of a trained medical provider haphazardly monitoring a BGL could be disastrous.  Here's a line I heard once, "Not that I checked because it would be beyond my scope, but _somebody_ reported the BGL @ _around _ 652 mg/dL three minutes ago."



Sorry to hijack, but i really don't understand how obtaining BGL are out of scope for EMT-Bs. Hell, even the average schmuck can check BGL.


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## TransportJockey

He's in CA. That's the reason alone that he can't do it. I know in every state I've worked in, EMT-Bs can check CBG


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## rwik123

NVRob said:


> Why not? Hypo/hyperglycemia is one of the H's and T's of ACLS and an easily reversible cause of an arrest...
> 
> We use King's not combi's, both do their job though.



Little late to jump on me for that. It's been cleared up earlier in the thread. ACLS? Sorry I'm a basic.


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## Handsome Robb

Doesn't mean you couldn't gather information for an incoming ALS crew if its within your protocols.

I know lots of basics that have ACLS provider cards. No such thing as too much education, it's not just limited to paramedics.


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## rwik123

NVRob said:


> Doesn't mean you couldn't gather information for an incoming ALS crew if its within your protocols.
> 
> I know lots of basics that have ACLS provider cards. No such thing as too much education, it's not just limited to paramedics.



Yeah I was wrong when I said that in the first place. I realize that I could in the future, handoff something to a first responder and check BGL. 

I just meant that I have no knowledge of the specifics of ACLS in regards to Hyper/hypoglycemia in an arrest situation, but I'm open to learn.


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## Deltachange

And I will thread hijack, if you get your ACLS as a basic, does your scope change for doing so? I am looking for a class, because I want to learn, but will it be immediately applicable if I do get the card?


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## rwik123

Deltachange said:


> And I will thread hijack, if you get your ACLS as a basic, does your scope change for doing so? I am looking for a class, because I want to learn, but will it be immediately applicable if I do get the card?



Your scope won't change. As I've heard, the ACLS for basics consists of setting up IV bags and place electrodes. I'm not sure if a basic can sit in a medic level ACLS course but If they could, I think it would be more knowledge based, not being able to do any of the interventions (100% sure on the scope not changing).


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## rwik123

And correct me if I'm know, ACLS for medics doesn't add any scope...just adds information and techniques with already learned interventions from your medic scope.


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## Deltachange

set up IV bags of what? With my IV I can already hang LR and NS, and the basic EKG course lets me set up electrodes for twelve leads. I would love the knowledge base anyways, because Cardiology and the meds fascinate me. Thanks!


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## Shishkabob

Deltachange said:


> And I will thread hijack, if you get your ACLS as a basic, does your scope change for doing so?



No, the card does not dictate your scope, your employer / state do.  All the card says is you passed a test.




I would recommend ACLS for EMTs.  You won't understand most of what is said / discussed if you're just fresh out of EMT school, but getting the basic thought process of what an ALS crew does in a cardiac arrest is always beneficial.  Only other way to get that information is to be on a bunch of cardiac arrests.


Join my truck... we've had 4 cardiac arrests in the past 6 shifts...


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## usafmedic45

> I know in every state I've worked in, EMT-Bs can check CBG



We never could as BLS providers.  Granted, we never let that stop us from having a "bystander" do it if the patient was a known diabetic and had a glucometer present.


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## Shishkabob

usafmedic45 said:


> We never could as BLS providers.  Granted, we never let that stop us from having a "bystander" do it if the patient was a known diabetic and had a glucometer present.



In Texas, it's viewed as a gray area as it's technically "invasive", though I don't know of a single service that doesn't allow it, and DSHS really can't dictate one way or the other.


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## TransportJockey

usafmedic45 said:


> We never could as BLS providers.  Granted, we never let that stop us from having a "bystander" do it if the patient was a known diabetic and had a glucometer present.



Heh, well so far that's only three states  Although now that I think about it, with the retarded EMT-B IV level in CO a true EMT-B can't check CBG. Just the IV add-ons can.


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## usafmedic45

Ah....like I said, we never let it stop us if we really thought it necessary.  Given our medical director's military background he was very much (at least for those of us in supervisory roles) of the "better to beg forgiveness than to ask permission" mindset on things that could be life or death.  Granted, having to beg forgiveness from that man was an experience I didn't relish so I was very judicious in the situations I put myself into needing to do that.  I'd rather teabag a rabid wolverine that is high on PCP in a locked telephone booth.


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## usalsfyre

usafmedic45 said:


> I'd rather teabag a rabid wolverine that is high on PCP in a locked telephone booth.


That's one hell of a visual.


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## Tigger

TransportJockey said:


> Heh, well so far that's only three states  Although now that I think about it, with the retarded EMT-B IV level in CO a true EMT-B can't check CBG. Just the IV add-ons can.



In the current CO Rule 500 (Colorado Board of Medical Examiners Rules Defining the Duties and Responsibilities of Emergency Medical Services Medical Directors and The Authorized Medical Acts of Emergency Medical Technicians), Blood Glucose Monitoring is an approved skill for all levels of providers. Also, no EKG class is technically needed to place electrodes and send data in Colorado, I know this was taught in my basic class. I think the combitube is similar in that its placement by basics is allowed, though at least in my area, your agency must provide you with additional training and approval.


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## TransportJockey

Tigger said:


> In the current CO Rule 500 (Colorado Board of Medical Examiners Rules Defining the Duties and Responsibilities of Emergency Medical Services Medical Directors and The Authorized Medical Acts of Emergency Medical Technicians), Blood Glucose Monitoring is an approved skill for all levels of providers. Also, no EKG class is technically needed to place electrodes and send data in Colorado, I know this was taught in my basic class. I think the combitube is similar in that its placement by basics is allowed, though at least in my area, your agency must provide you with additional training and approval.



Heh makes sense. Since I only worked briefly in co I couldn't remember. Besides I was an I/85 that git stuck as a B IV... Never did classes in co.


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## Deltachange

TransportJockey said:


> Heh, well so far that's only three states  Although now that I think about it, with the retarded EMT-B IV level in CO a true EMT-B can't check CBG. Just the IV add-ons can.



Living in Colorado, and just getting my IV class, we discussed that, and it is no longer true. Once rule 500 expired and control of the scope was passed on, the ability to check BGL is now within the scope of Colorado EMT B's.


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## MediMike

marcus2011 said:


> If adequate ventilation is being done with a combi or a king with bilateral chest rise then by all means leave the BIAD in place. Taking the time to remove the tube when the medics get there to drop a ET tube could be used in better things like getting an iv set up, switching monitors if yours does not have a *Manuel* shock or other things like that



Your monitors manufactured in Mexico?


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## bigbaldguy

MediMike said:


> Your monitors manufactured in Mexico?



Hola yo soy Manuel. I am here to deliver the shock, si?


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## Smash

bigbaldguy said:


> Hola yo soy Manuel. I am here to deliver the shock, si?



I guess that's a new take on "I'm here to clean your pool!"


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## Martyn

rwik123 said:


> New protocol! Genius. It'll be a whole new thing, basics pushing meds up people's butts.



When I worked as a care assistant for people with learning disabilities back in the UK we were trained and authorised to use rectal valium. The pt who was prescribed this was a fairly OK individual and I often had this scary thought...what if I was out shopping with him in the UK equivalent of, say, Walmart and he went status and I had to administer the rectal valium in the middle of the food aisle?  :unsure:


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## sirengirl

Martyn said:


> ...what if I was out shopping with him in the UK equivalent of, say, Walmart and he went status and I had to administer the rectal valium in the middle of the food aisle?  :unsure:



"Clean up on aisle 3."


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