esophageal detection device

[ArcticKat]

We've just been approved for Medication Facilitated Intubation. We're to use a combination of either Midazolam/Fentanyl or Etomidate/Fentanyl.

For confirmation of tube placement we have to use both quantitative etCO2 and an Esophageal Detection Device. I've never used an EDD before, basically, from what I can tell, it's a glorified syringe that fits on the end of the ETT, if you can aspirate air you're in the trach, if you feel resistance, you're not.

Has anyone used these?
Any favorites?

 

[abckidsmom]

We used the syringe one a few years ago, and also the bulb syringe looking one that was about the same size as a tennis ball.

Both have gone by the wayside. We now only have ET CO2 monitoring, and easycaps.

I didn't mind either, but I never learned anything from the EDDs that I didn't already know from the easycaps.

My .02.

 

[NomadicMedic]

Learned how to use the EDD in medic school, but I've never used one. We use ETCO2 as the definitive method of confirming tube placement.

 

[MrBrown]

We use EDD and ETCO2 along with the traditional qualitative methods of tracheal placement - lung sounds, misting etc

Brown is surprised you are only getting medication assisted intubation and not proper RSI; we use fentanyl/ketamine and suxamethonium

 

[Smash]

In my experience the ODD adds nothing but a wasted step in the process. They are not accurate in many situations that we find ourselves in, such as intubating stiff lungs, obese patients, airways that have aspirate in them and so on. They tell you nothing useful if you have proper waveform capnography.

 

[Shishkabob]

Never used an EDD on a real intubation, but it's a pretty simple device... however, as always, don't rely on just it alone to determine if you're in.

 

[usalsfyre]

Waveform capnography is the standard. Putting anything else on the tube to tell if your end is indeed a wast of time. We had them here at one point, we don't anymore if that tells you anything.

 

[ArcticKat]

You guys are pretty much telling me what I'd already suspected. I don't know what prompted the powers in command to insist that we also use the EDD but we must do both. This was a very contentious protocol that took many years of "back and forth" before it was finally approved. For the next couple of years it is going to be monitored very very closely by our professional college, the College of Physicians and Surgeons, and the Ministry of Health. Any missteps could see the protocol removed from our bag of tricks in quick order.

As to Brown's question, our protocols are approved by the provincial College of Physicians and Surgeons. Unfortunately, or perhaps fortunately, they are a cautious bunch and like to take baby steps. To that end they approve the bare minimums and then expand once they feel everyone has caught up on the learning curve. I'm hoping that in a year or two the EDD falls by the wayside.

 

[usalsfyre]

What's unfortunate is that "medication assisted intubation" actually sets you up for failure.

 

[Shishkabob]

Etomidate + no paralytic for when you get trismus = uh-oh.

 

[Smash]

It never ceases to irritate me. RSI has to be done properly or not at all. Half measures make for poor outcomes.

 

[MrBrown]

Half ... make for poor outcomes.

Brown was born at 26 weeks, so is living proof that things half done make for poor outcomes

Hmm, Brown had best delete this before Kate sees it, dang Mrs Brown being literate on teh internetz and all

 

[ArcticKat]

It never ceases to irritate me. RSI has to be done properly or not at all. Half measures make for poor outcomes.

Many of us are in agreement. Thus this protocol is unlikely to be actually used as often as it could be.

 

[MrBrown]

We had midazolam assisted intubation for a number of years during the 1990s and early 2000s which preceeded our RSI program introduced in 2005

Good things take time

 

[Smash]

Many of us are in agreement. Thus this protocol is unlikely to be actually used as often as it could be.

It's unfortunate, you want to use it to demonstrate that it is sub-optimal, but of course you don't want to use it because it is sub-optimal...

I hope you can talk them around, RSI is something that can really make the difference between good outcomes and bad when done properly.

 

[Shishkabob]

I hope you can talk them around, RSI is something that can really make the difference between good outcomes and bad when done properly.

One of the worst feelings I've felt is having a patient decompensating and going in to respiratory arrest and all you can do is stare at them...

 

[bstone]

EDD=Turkey Baster

 

[NomadicMedic]

One of the worst feelings I've felt is having a patient decompensating and going in to respiratory arrest and all you can do is stare at them...

Why? You didn't have a BVM?

 

[abckidsmom]

Why? You didn't have a BVM?

With an acutely decompensating patient, would you really be able to fight them with a BVM? Would it do anything, really?

 

[NomadicMedic]

I saw "going into respiratory arrest..." That sounds like indications to break out the bvm to me.