Advanced Airway: unconscious to conscious

[johnguillen68]

Ok, if I'm transporting a pt that had to be intubated, but along the trip to the hospital the pt's conditions improves and becomes combative, pt appears to be breathing without assistance: what can I do?

1 -request a paramedic to give her a sedative drug
2 -contact medical control for instructions
3 -have suction ready and remove ET tube
4 -restrain pt and continue ventilations

 

[VentMedic]

???????????????????

What level are you and are you by yourself and must call for an ALS intercept?

Is this a test question or from real experience?

I also thought they were doing away with ETTs in your area and going with just the suprglottic?

 

[Sasha]

No one here is going to be able to take the NREMT for you, I suggest instead of asking all these questions you go back and reread your textbook.

 

[johnguillen68]

No one here is going to be able to take the NREMT for you, I suggest instead of asking all these questions you go back and reread your textbook.

its a question thats on a practice sheet. I don't have my EMT book to look at that advance airway chapter. I don't know why that question is even in this quiz. Its a scenario question.
Plus its a forum you're supposed to ask questions that you don't know and I don't know this one.

 

[LAS46]

Ok, if I'm transporting a pt that had to be intubated, but along the trip to the hospital the pt's conditions improves and becomes combative, pt appears to be breathing without assistance: what can I do?

1 -request a paramedic to give her a sedative drug
2 -contact medical control for instructions
3 -have suction ready and remove ET tube
4 -restrain pt and continue ventilations

First off... What level of EMS are you??

Are you in this question on a Iner Facility Transfer (IFT)? Who started the ET?

If it was like any other advanced airway (i.e. combi-tube, king tube, LMA) I would follow the same procedure for those, which is to remove them and have section ready. If you are on a IFT and you are a basic level I do not think you should be transporting someone with a ET in unless there is a EMT-I or P on board monitoring that PT while you are driving.

Hope you understand this.

:usa:

 

[johnguillen68]

First off... What level of EMS are you??

Are you in this question on a Iner Facility Transfer (IFT)? Who started the ET?

If it was like any other advanced airway (i.e. combi-tube, king tube, LMA) I would follow the same procedure for those, which is to remove them and have section ready. If you are on a IFT and you are a basic level I do not think you should be transporting someone with a ET in unless there is a EMT-I or P on board monitoring that PT while you are driving.

Hope you understand this.

:usa:

EMT-B and it was a scenario question that was on a quiz. I don't know why this question was brought into this quiz but I didn't know the answer so I brought to this site.
I'm not asking anybody to take the NREMT for me. I am practicing to retake the test and on one of the books I bought to practice had this question. I didn't know the answer to this question and was concern that it might pop up on my test. Thats all.

 

[Sasha]

its a question thats on a practice sheet. I don't have my EMT book to look at that advance airway chapter. I don't know why that question is even in this quiz. Its a scenario question.
Plus its a forum you're supposed to ask questions that you don't know and I don't know this one.

You aren't supposed to use us to do your homework. if you have a question on a quiz who better to ask then the one who gave the quiz?

 

[LAS46]

You aren't supposed to use us to do your homework. if you have a question on a quiz who better to ask then the one who gave the quiz?

Sasha you are not understanding what he is saying... The question he has is from a book that he is using as a review, not from a test that he is doing.

 

[VentMedic]

If it was like any other advanced airway (i.e. combi-tube, king tube, LMA) I would follow the same procedure for those, which is to remove them and have section ready. If you are on a IFT and you are a basic level I do not think you should be transporting someone with a ET in unless there is a EMT-I or P on board monitoring that PT while you are driving.

Hope you understand this.

A supraglottic device is very different than an ETT (subglottic). Most patients can not tolerate a supraglottic device when awake and will need to have them removed. An ETT is considered a definitive airway and may be there for a very good reason. If you remove it, you may now have LOST the airway. This is also a good chance they will vomit compounding whatever airways issues were present. Then you might also have to worry about laryngeal edema or spasm. Then, if your Paramedic can not do RSI, the patient may die.

You had better have your Paramedic sedate this patient to keep that airway. This is also a serious hit on the Paramedic for not monitoring the patient's vital signs and sedation level. Even an EMT-I should not be monitoring an intubated patient that may require enough sedation to maintain an airway for adequate ventilation and oxygenation.

If for some reason beyond belief that it is only you as an EMT-B with this patient, you would have to restrain and maintain control of the airway. However, your ability to ventilate and oxygenate this patient may be very poor even with the tube in place.

 

[LAS46]

A supraglottic device is very different than an ETT (subglottic). Most patients can not tolerate a supraglottic device when awake and will need to have them removed. An ETT is considered a definitive airway and may be there for a very good reason. If you remove it, you may now have LOST the airway. This is also a good chance they will vomit compounding whatever airways issues were present. Then you might also have to worry about laryngeal edema or spasm. Then, if your Paramedic can not do RSI, the patient may die.

You had better have your Paramedic sedate this patient to keep that airway. This is also a serious hit on the Paramedic for not monitoring the patient's vital signs and sedation level. Even an EMT-I should not be monitoring an intubated patient that may require enough sedation to maintain an airway for adequate ventilation and oxygenation.

If for some reason beyond belief that it is only you as an EMT-B with this patient, you would have to restrain and maintain control of the airway. However, your ability to ventilate and oxygenate this patient may be very poor even with the tube in place.

Now that you have put it that way I can understand that. But like I said, If you are only a BLS unit you should not be transporting this patient. If it was me doing a IFT with this type of PT I would have to refuse the transport because that PT needs a ALS unit or a Chopper ride to the other facility.

 

[Mountain Res-Q]

All the options given suck:

1 -request a paramedic to give her a sedative drug
Who he hell am I as an EMT to tell the medic what to do. Shouldn't he know?

2 -contact medical control for instructions
When given an answer that you can't answer, this is usually what the test wants you to say.

3 -have suction ready and remove ET tube
Where in the EMT cirriculum does it teach EMT's how to extubate? Beyond the medical contriindications for an EMT doing so, this is just STUPID!

4 -restrain pt and continue ventilations
Can we say assault? Not to mention, why the hell you wou ventalate a patient that is already moving air adequately?'

The real answer: Don't be the primary care provider at the EMT level on a transport of a patient with an advanced airway, which is usually an indication of an injury/illness for which you can provide limit care a the BLS level.

 

[Shishkabob]

What is a BLS unit doing transporting an intubated pt?

 

[Sasha]

What is a BLS unit doing transporting an intubated pt?

Maybe they're EMT+'s

 

[rmellish]

What is a BLS unit doing transporting an intubated pt?

Not under my protocols. For good reason too....

 

[LAS46]

What is a BLS unit doing transporting an intubated pt?

In Colorado, NO EMT-B or I can transport a intubated PT. I still would recommend a PT who needs a IFT to another hospital should be flown due to the shortage of units available in my area.

Just my opinion.

 

[rmellish]

In Colorado, I still would recommend a PT who needs a IFT to another hospital should be flown due to the shortage of units available in my area.

Just my opinion.

Guess I don't really know your area, but that seems a bit excessive. Intubated patients can go by ground...

 

[LAS46]

Yes they can go by ground but I perfer to send them by air.

 

[Shishkabob]

Why? Just because they have a tube down their throat?

 

[Sasha]

In Colorado, NO EMT-B or I can transport a intubated PT. I still would recommend a PT who needs a IFT to another hospital should be flown due to the shortage of units available in my area.

Just my opinion.

So, you want to put the entire flight crew at risk (You've heard all those stories about them crashing!) for something that could've gone by ground?

Not to mention tack on the helicopter bill which I imagine is significantly more than an ambulance bill to their final total.

And I think there are fewer helicopters then there are ALS ground units.

 

[Shishkabob]

Along with tying over an air ambulance, and screwing over air traffic control.