Airway Study.... Thoughts?

[olaf1988]

I feel like every study I read does not answer some core questions. This one appears to leave out the difference between ALS and BLS airways, whether they're talking about using a backboard while supine or just on the gurney, and the severity of the patient. It seems odd to make a blanket statement that putting a patient supine will compromise the airway. I can't seem to access the full text, but I was wondering if anyone else has any thoughts on this?

http://www.jems.com/articles/print/...-unconscious-patients-in-supine-position.html

 

[MS Medic]

While there might not be a lot of studies on the topic, the results aren't all that shocking. Basic BLS management for an airway is to move the pt into a lateral or some level of fowler's position for a nontrauma pt with airway compromise. A pt with AMS might have issues with the tongue occluding the airway or have the inability to remove secretions. To showcase the point, when an altered pt starts vomiting, one of the first things you do is roll them to a lateral position.

I think this this a good complement to studies that show the general ineffectiveness of the LSB post mechanism and in my personal anecdotal experience the under use of the KED which allows you to sit a spinal immobilized pt upright.

Evidence based studies are a good thing for EMS. This will allow us to get away from things we do that are standard of care that don't have a lot of justification.

 

[olaf1988]

I'm not arguing that this isn't an important topic, or that there shouldn't be more evidence based studies. I just have a problem with the blanket statement that putting a pt supine causes airway compromise. While it plays a role, everything you're describing could be fixed by proper airway management. The idea that the airway is compromised by the position also implies that the EMS crew either failed to recognize the problem with the airway or simply didn't correct it. To me, this means that we need better airway management training- you can't simply blame the position alone for the airway issues.

The other thing I mentioned was that the article doesn't differentiate between patients who are immobilized and simply placed supine for airway management.

 

[Carlos Danger]

I feel like every study I read does not answer some core questions. This one appears to leave out the difference between ALS and BLS airways, whether they're talking about using a backboard while supine or just on the gurney, and the severity of the patient. It seems odd to make a blanket statement that putting a patient supine will compromise the airway. I can't seem to access the full text, but I was wondering if anyone else has any thoughts on this?

I would suggest you read the actual study.

I was able to find the full-text for free with s quick Google search:
http://www.sjtrem.com/content/23/1/50

 

[olaf1988]

Thanks for the full-text- it clears up the fact that they're studying unprotected airways.

I just think that the JEMS article left out a sizable amount of information and made blanket statements without qualifying them. I think that instead of "The supine position compromises the airway in patients with altered mental status", the conclusion I see from all this (and from reading the full-text, plus the referenced articles) is "The supine position may compromise the airway in patients with altered mental status when the airway is left unprotected".