BLS Intubations

[medic03]

I gota ad my 2 cents. I think it's a great idea for EMT's to use combitubes. it helps secure an airway, you get less gastric distention (come on, I know you have all seen the rookie bag the pt at a rate of 40X a min and with as much force to cause a double pneumo) and it's one less thing an als provider has to be concerned with during an intercept. You can't push drugs down (unless you are a mirical worker and get it in the trachea) but that's what IV's are for. if you got no IV access, then remove and try for an ETT, but I would love to see a combitube inplace prior to my arrival (on a cardiac arrest or resp arrest pt). as for ECG monitoring and interp strips, I'm leaning towards no. There is so much info you have to take into concideration when reading a strip and so many diffrent effects meds do, that I feel if you want to hook up the monitor, then become an als provider. Plus that desire to just see what rhythm the pt is in even when not an als call might become too great and that's not something an EMT -b should be doing. If you want to learn to better yourself, that's great and I'm all for that, but not for interpreting rhythms in the field as a non als provider.

 

[Jon]

Originally posted by medic03@Jan 31 2005, 02:07 PM
I gota ad my 2 cents. I think it's a great idea for EMT's to use combitubes. it helps secure an airway, you get less gastric distention (come on, I know you have all seen the rookie bag the pt at a rate of 40X a min and with as much force to cause a double pneumo) and it's one less thing an als provider has to be concerned with during an intercept. You can't push drugs down (unless you are a mirical worker and get it in the trachea) but that's what IV's are for. if you got no IV access, then remove and try for an ETT, but I would love to see a combitube inplace prior to my arrival (on a cardiac arrest or resp arrest pt). as for ECG monitoring and interp strips, I'm leaning towards no. There is so much info you have to take into concideration when reading a strip and so many diffrent effects meds do, that I feel if you want to hook up the monitor, then become an als provider. Plus that desire to just see what rhythm the pt is in even when not an als call might become too great and that's not something an EMT -b should be doing. If you want to learn to better yourself, that's great and I'm all for that, but not for interpreting rhythms in the field as a non als provider.

It is however, always nice as an ALS provider to have BLS personel to attach the leads, etc, as that is one less thing for you to do. However, I agree that BLS people should not try to read the strips.

I've worked a code or 2 where the medic (knowing I'm going through P-school) has asked me "what does that look like" - Once, my response was, "well, sort of agonal with a bunch of I don't know what." let me see - yep agonal with something, but it ain't motion artifact.

the other - "Ummm...looks like v-fib. someone want to shock this" (as I slap the other fast-patch pad on the patient - for some reason they had the 3-leads on) Medic B then shows up and medic A tells him to shock....


Jon

 

[Phridae]

Around here Basics can use combitubes. ET tubes are strictly a medic skill, I think. I'll look into that. I'm just fine with the combitubes. They're pretty much fool-proof if you've been trained. Maybe thats why basics can use them here....

And the derailment that this topic took was crazy. Glad to see someone put the train back on its tracks.

 

[shorthairedpunk]

Our basics have been intubating for over a decade now, its a monkey skill, I dont understand why people make such a big deal about this. The majority of the intubations in this system are done by BLS providers with equivalent success rates to ALS only intubation systems.

 

[Wingnut]

I'm also a CPR instructor, and I get articles and newsletters from our local hospitals. A few of the articles I have received lately are about how intubating with an ET tube may not be very effective, and I read a study somewhere claiming that pt's who were intubated out in the field were less likely to survive than those intubated in an ER. (I wish I could remember where I read it, it wasn't conclusive and I don't know where the study was done, but it's something they are checking out.)
I don't see how any of that can be remotely possible as securing an airway is numero uno in this field.
But maybe all the debate has something to do with EMT-B's being restricted. While we can use combitubes here, when we go to medic school and learn to intubate with ET tubes, it's its own mini-class and you have to have some 20-30 successful intubations on a cadaver to pass.

 

[colafdp]

Well here in Saskatchewan, at the Primary Care Paramedic level (Formerly known as the EMT) we are allowed to cardiac monitor, and are expected to interpert the strip (that's why we're taught all the different rhythms) and plus within the next year they are expecting that ET Tubes, as well as some emergency meds (Epi, Ventolin, Nitrous, and Diazepam) are going to brought down to the basic level. So it's interesting, cause the basics, aren't really basics anymore.

 

[Jon]

Originally posted by colafdp@Feb 27 2005, 02:09 PM
Well here in Saskatchewan, at the Primary Care Paramedic level (Formerly known as the EMT) we are allowed to cardiac monitor, and are expected to interpert the strip (that's why we're taught all the different rhythms) and plus within the next year they are expecting that ET Tubes, as well as some emergency meds (Epi, Ventolin, Nitrous, and Diazepam) are going to brought down to the basic level. So it's interesting, cause the basics, aren't really basics anymore.

OK, everyone, I'm moving to Saskatchewan



jon

 

[Phridae]

Originally posted by colafdp@Feb 27 2005, 02:09 PM
Well here in Saskatchewan, at the Primary Care Paramedic level (Formerly known as the EMT) we are allowed to cardiac monitor, and are expected to interpert the strip (that's why we're taught all the different rhythms) and plus within the next year they are expecting that ET Tubes, as well as some emergency meds (Epi, Ventolin, Nitrous, and Diazepam) are going to brought down to the basic level. So it's interesting, cause the basics, aren't really basics anymore.

Holy cow. Being a basic in wisconsin pretty much sucks! As far as I can remember, the only drug we can give is asprin. For everything else, we have to call for orders or it has to be the pt.s own. Again, I'm not real sure anymore. I'm on a medic squad, so I never have had to call for orders and I'm not clear on what I'm allowed to legally give anymore.

 

[Jon]

Originally posted by Phridae@Mar 6 2005, 04:45 PM
As far as I can remember, the only drug we can give is asprin. For everything else, we have to call for orders or it has to be the pt.s own.

Thats better than PA.

It USED to be that we could ASSIST the Pt. admin. thier own Fast-acting inhaler, epi-pen, or NTG, but now we can carry our own epi-pens.


Otherwise - nothing.


Jon

 

[Ray1129]

Hmmm....it is very interesting to see who can give what and where and who can't. Here in MD, we're definately not allowed to give aspirin. We're allowed to give O2, Epi-pens, Pt. prescribed NTG, Pt. prescribed Albuterol, Charcoal w/ consult, and Ipecac w/ consult. It's crazy to see what everyone else can do above us. And vice-versa....

-Ray

 

[rescuecpt]

Originally posted by Ray1129@Mar 15 2005, 01:22 AM
Hmmm....it is very interesting to see who can give what and where and who can't. Here in MD, we're definately not allowed to give aspirin. We're allowed to give O2, Epi-pens, Pt. prescribed NTG, Pt. prescribed Albuterol, Charcoal w/ consult, and Ipecac w/ consult. It's crazy to see what everyone else can do above us. And vice-versa....

-Ray

Suffolk Cty NY is the same except we can give our own albuterol.

 

[rescuejew]

We dont run basic response in the county I work in, our first responders are all ALS, but I do have an opinion.

I think in rural settings when an ALS provider is several minutes away, a CT would be ideal for basics to be able to utilize. Intubation, Im not so sure about. We let Intermediates intubate here and we have a pretty good record, but the average has gone down adn we have since stopped letting newly hired EMT-Is intubate because county intermidates and fire dept intermediates are quick to secure an airway with a combitube when intubation seems impossible. Sometimes this is done before a county medic is even on scene to attempt the intubation. I have to address a comment I read earlier about taking a CT out to attempt to intubate. CT should be used as a last resort. ET Intubation is the best airway one can get, and CTs should only be used in the event that all atempts at ET Intubation have failed. Removing a CT to Insert and ETT for med administration will further traumatize an already traumatized airway, you may not be able to intubate after a CT is pulled.

On EKGs: When I first get to a pt, I want to know several things about the HR, regular? fast or slow? present or absent? beyond that, there needs to be monitor wih 4 and 12 lead capabilities and someone there to interpret it. And no offense, after the Franklin county fiasco, no one is going to tell me anything about a pt I will ultimately be responsible for that I am not going to re-verify myself. If people want to be proactive, thats awesome, I recommend Dale Dubins 12 lead EKG guide. Its a great book for explaining heart rhythms and physioanatomy.

 

[Punisher]

I work down in Central Florida. We have epecac on our rigs. But we don't even bother with it. You need permission from the md. Usually the medic that I work with doesn't even bother calling. Its a load and go situation.

I agree with rescue on the ct tubes. Me and my partner, also an EMT-b only use ct tubes if there will be a delayed response of ALS.

 

[MedicPrincess]

Around there the units are all staffed ALS...one medic, one basic. So pretty much whatever the protocols allow for the medics to use, they use.

Basics can give O2....and pretty much thats about it. The medics give the rest.

 

[TTLWHKR]

:wacko:

 

[rescuemedic7306]

Not wishing to wave the ol' "I remember when.........' flag but....
I started in EMS in 1975 when we were basic, with a capital 'B'. (mind you, this was in the UK!) Then in 1980 I become one of the first advanced intubation and IV medics which took 560 hours of training and clinicals.......nowadays (I believe) it's a 40 hour course, at least in Minnesota, which shows how things change. As for Intubation, it still seems to be one of the most jealously guarded skills of all, which is strange since I took part in an 'intubation obstacle course' in 2003 (not having wielded a laryngoscope in anger for more than 15 years) and came 3rd out of 20, the field comprising numerous medics and CRNAs. Maybe it's like riding a bike?

Personally, I think a lot of guff is talked about intubation and how it's so difficult and dangerous and how only men and women of iron nerve and vast experience can possibly hope to accomplish it successfully. Seems to me it's more that people are guarding their turf. If it is the 'gold standard' of airway and patient care, it should be a skill that's taught to all, especially in Rural EMS where it can be 30 minutes and up to an ER or medic intercept, even if it means sticking another 60 or so hours on the curriculum.

PS. I REALLY like the Combitube though, it's quick, easy and effective and it's part of the EMT-B course in MN.

 

[KEVD18]

how do you folks feel about lma's?

dont know a whole lot about them but from what i know, they sound like a really cool toy to have

opinions?>

 

[Jon]

Originally posted by KEVD18@Apr 27 2005, 10:09 AM
how do you folks feel about lma's?

dont know a whole lot about them but from what i know, they sound like a really cool toy to have

opinions?>

LMA's are nice, and cause less trauma to the airway. As a backup airway, I like the intubationg LMA i've seen. The LMA itself isn't real great for prehospital use - it doesen't fully protect the trachea. I like it a lot better than bagging someone, but Intubation is still the "gold standard"

Jon

 

[rescuecpt]

We can't use LMA's but I think they're great. When I have my back surgery I'm going to request an LMA rather than a ET tube, if the situation allows.