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    Airway Management and Intubating without Drugs

    I don’t mean to direct any hate towards you, but king county is considered to be a Mecca for paramedics.. To think that you need to go through some extensive T&E before implementing a BLS procedure that is the standard of care across the nation for at least 5 years now just floors me. I mean...
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    Airway Management and Intubating without Drugs

    Municipal 911, will do local ER to ER IFT in an emergency and no privates available, but it's extremely rare..
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    Airway Management and Intubating without Drugs

    Our RSI protocol right now is 1mg/kg ketamine and 1mg/kg rocuronium.. Works well and we've not seen any hemodynamic issues with it
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    Airway Management and Intubating without Drugs

    Even at lower doses (1mg/kg)? I'm not doubting you, I just haven't seen it myself..
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    Airway Management and Intubating without Drugs

    Holy cow.. that honesty surprises me.. I’m guessing you guys still regularly RSI your CHF patients then? That probably explains why your system has so many intubations these days..
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    To Degree or Not to Degree. That is The Question.

    I’m curious.. What is the practice environment for those of you who are vehemently in the “all medics should have degrees” camp? In my neck of the woods, everyone and their sister is a paramedic, and the majority of the work they do is BLS transport. I am in the “medics in leadership and...
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    Airway Management and Intubating without Drugs

    Yeah that was my first reaction with the oxygenation criteria as well..
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    Airway Management and Intubating without Drugs

    Versed is vasoactive, as is etomidate, the two of them together can drop pressure.. Funny you mention bolstering the oxygenation. One of the topics at Eagles this year was the idea of NOT initiating your RSI until you have the SpO2 above a certain threshold (I think it was 95 but that may be...
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    Airway Management and Intubating without Drugs

    I remember the days of Etomidate and Versed.. Etomidate at 0.3mg/kg but with a max dose of 20mg, half our people clamped down almost immediately. The fix, at the time, was doubling the Etomidate dose (it worked)..
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    Airway Management and Intubating without Drugs

    My feeling is that it has to do with our ability to truly assess how deeply sedated they are.. "Hey, they seem to accept an oral airway, lets cram a laryngoscope in there" only to find that the deeper stimulation led to gagging, spasms, vomiting, aspiration, etc etc.. This is echoed in that...
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    Airway Management and Intubating without Drugs

    https://www.ncbi.nlm.nih.gov/pubmed/10102312 It is admittedly a small study, but this is the first one I came across
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    Airway Management and Intubating without Drugs

    Then again, there is at least one study out there that says emergent intubation without NMB correlates to an increase in complications as well as morbidity/mortality..
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    Airway Management and Intubating without Drugs

    It’s possible, given their reportedly highly functioning tiered systems. The impression they give is that their paramedics truly treat and transport sick als patients, and the rest are taken by FD staffed BLS ambulances..
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    Airway Management and Intubating without Drugs

    Definitely would have loved to work in a system like KC.. That said - you should look up the Driver et al study on the Bougie, 10-12% first pass success rate increase between styles and Bougie, and that’s in a well lit ER with plenty of hands, I think you guys would see a similar increase.
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    Narrative vs entire PCR

    Lol, ok bro.. go on and believe that.
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    Airway Management and Intubating without Drugs

    The bougie is just better than a stylet. I pulled the stats at my department for the last 3 years and found (over the 3 year query) an average of 3 intubations, with an outlier of 11, a handful in the 4-6 range, and a mode of 1, meaning the majority of my folks have only intimated 1 time in 3...
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    Airway Management and Intubating without Drugs

    Funny you say that about bougies - I’m phasing our regular stylets for bougies at work. I’ve always been a fan of the bougie, the study by Driver et al was pretty convincing evidence that it’s time to dump the traditional stylet.. I also recently put DuCanto tips in service.. As for your...
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    Narrative vs entire PCR

    I'm going to go out on a limb and say you're at the 3-10 year mark in your career, where ego and anti-management attitude tends to overwhelm your ethos.. I'm also going to assume that you've never spent a second doing system-wide chart review. Chart review is absolutely not the ONLY metric I...
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    Narrative vs entire PCR

    <shrug> ok.
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    Narrative vs entire PCR

    Are you implying that you work for some mythical agency where everyone is at the top of their game at all times and never need to grow? Give me a break..
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