Airway Management

medicsb said:
Actual need for a gastric tube in the prehospital setting is rare. Anyhow, the gastric tube should be placed orally (nasal route is a risk factor for VAP). To help you can have someone perform a jaw thrust or you can use your nondominant hand to grab the mandible and distract it anteriorly while inserting the tube. Still having trouble? Just stick you finger in the back of the throat to help guide it. Be care not to force it if you're getting a lot of resistance. (In the past year where I'm working, a medicine resident caused a pneumo while placing a dobhoff tube, which managed to make its way past the cuff of the ETT and into a lung. OOPS!)
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How do you recover from a mistake like that? Don't get me wrong, I'm not trying to say I could not have made the same mistake but I think I'd have to quit.
 
SeeNoMore said:
How do you recover from a mistake like that? Don't get me wrong, I'm not trying to say I could not have made the same mistake but I think I'd have to quit.
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that's why they call it practicing medicine
 
A trick I learned from a senior medic who is also a respiratory therapist is to have your partner(or your friendly neighborhood firefighter) hook the patient's right cheek out of the way. Such a simple trick but it helps so much.
 
I got really good with the bougie, then decided to start using the king vision.. Man, that thing is like cheating..
 
FiremanMike said:
I got really good with the bougie, then decided to start using the king vision.. Man, that thing is like cheating..
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We've started using vividtracs at our system. I'm not a fan because you have to hook into a laptop. Something like the king vision seems like it would be a better alternative.
 
SeeNoMore said:
How do you recover from a mistake like that? Don't get me wrong, I'm not trying to say I could not have made the same mistake but I think I'd have to quit.
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Mistake? The resident just scored an extra chest tube (I kid...).
 
 
The Fastrach is a good device, but there are newer LMA's that you can intubate though with a normal ETT.

I know there are a few out there, but the Air-Q is the one I've used quite a bit. It's a great LMA on it's own, and intubating through it is easier than the Fastrach.
 
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SeeNoMore said:
How do you recover from a mistake like that? Don't get me wrong, I'm not trying to say I could not have made the same mistake but I think I'd have to quit.
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Better than the NG tube in the brain....

We use non-weighted dobhoffs. Supposedly, injuries where much more common with the old weighted ones. OGs in the lung happen every now and then.

There is really no reason to place an NG on an intubated patient. It will likely be pulled and replaced with an OG in the ICU. Except those patients you know will need it after extubation, ie belly surgeries, but not really a concern for most.

Also a yankauer works well to help guide it where it needs to go.
 
@Chase i-gel


We recently had a separate discussion on it here.

Air q LMA


Looks like an LMA with a big inner diameter.
 
Mac 3 or miller 2 for all standard adult intubations. Bougie is opened and shoved under the pts shoulder so all I have to do is grab it and pull it. First pass success should be the name of the game with something changing between attempts.
 
The size of the laryngoscope used is also a factor. I'm not quite sure where I read this but some anesthesiologists prefer to almost exclusively use a smaller laryngoscope for most patents (size 2). They "choke up" on the handle to where their pinky and/or ring finger are physically on the blade. Too large of the blade just gets in the way, making it more worrisome to lift having to use a lever and there being too much blade deeper into the oropharynx and obstructing anatomical landmarks.
 
MonkeyArrow said:
The size of the laryngoscope used is also a factor. I'm not quite sure where I read this but some anesthesiologists prefer to almost exclusively use a smaller laryngoscope for most patents (size 2). They "choke up" on the handle to where their pinky and/or ring finger are physically on the blade. Too large of the blade just gets in the way, making it more worrisome to lift having to use a lever and there being too much blade deeper into the oropharynx and obstructing anatomical landmarks.
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That is exactly what I do. Miller 2 for almost everyone. I hold the scope in my left hand with only my thumb, index, and middle finger on the handle so that I can use my left pinky finger to flick open the lips and push the tongue forward as I slide the blade into the mouth. My right hand is available to lift the head, grab the bougie, manipulate the glottis, whatever.
 
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