BVM mishap. Did I do something wrong?

RobertAlfanoNJEMT said:
Does it hurt them to insert an NPA? No. And if I do it I know their airway is secure and I can focus on treating their other presenting life threats and ailments..
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You do realize you or your partner can position the airway and assist ventilations right? Do that til ALS gets Narcan going. Especially if they are breathing on their own somewhat well.
 
gotshirtz001 said:
1. ALS Fire often gets there first... Unless the ALS ambulance does.
2. ALOC is not a BLS call.
3. No one is saying that an NPA is a bad move... Saying to ALWAYS do (insert thing here) is a bad practice even if it's just an NPA (and they do kinda hurt). If an intervention is indicated; do it.
4. I remember being an EMT... I have since realized I didn't know ****.


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Not in Jersey! PD is first on scene then BLS second and third ALS. So until ALS gets there it is a BLS call.. Just because you didn't know **** as a basic doesn't mean the rest of us don't..
 
WolfmanHarris said:
A little bit of knowledge is a dangerous thing.

Anecdotal evidence, that is what you learn from direct experience, is dangerous because it has a greater impact then knowledge gained from data. This is a common pitfall for providers who begin to make decisions based on past experience (good/bad) and pattern matching. Take a step back let your hackles down and realize there is good I for here from knowledgable clinicians that you can learn from. You seem to be taking disagreement very personally.

As far as ALS providers staying out of BLS forum, well in my system I am a BLS provider so I think I'll stick around.

Let's take a few steps back and consider the OD patient requiring ventilatory and airway management.

First toxidromes. What drug has been taken and how is it effecting their respirations? Opiates and benzos are going to suppress respiratory drive as well as being sedative. Assume this patient is presenting w/ bradypnea, decreased O2 sats, hypercapnea and decreased LOC.

You begin to assist ventilations and insert an airway adjunct. As you're bagging them they begin to moan and move about as you've described. Consider at this point that the patient's condition despite not being reversed via narcan may have improved due to improved oxygenation and ventilation. So yes, your OD patient is demonstrating the behaviour you described, but I would argue that at this point reassessment is indicated which may find that their inherent respiratory rate and depth as well as improved LOC may make continued used of an airway adjunct unnecessary.
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I agree and I believe we are saying pretty much the same thing
 
StCEMT said:
You do realize you or your partner can position the airway and assist ventilations right? Do that til ALS gets Narcan going. Especially if they are breathing on their own somewhat well.
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1) my partner may very well just be a driver depending on what time of the day the call comes in
2)Narcan is a BLS medication that we now carry
3)it's a soft tube that goes up their nose
I don't know why everyone is up in arms about it! You can do more damage by not inserting one when it is needed than inserting one when it is not needed. You are lashing out against my attitude not my choice of patient care management
 
RobertAlfanoNJEMT said:
Not in Jersey! PD is first on scene then BLS second and third ALS. So until ALS gets there it is a BLS call.. Just because you didn't know **** as a basic doesn't mean the rest of us don't..
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By definition, with the curriculum, basics are under educated in every aspect of emergency medicine. And the fact als is last on scene is one of many reasons I would never move there
 
TransportJockey said:
By definition, with the curriculum, basics are under educated in every aspect of emergency medicine. And the fact als is last on scene is one of many reasons I would never move there
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That is fine with me, stay in Texas! Most 911 calls in Jersey are answered by volunteers.. People who care about their patients and community. You guys could learn from us!
 
RobertAlfanoNJEMT said:
That is fine with me, stay in Texas! Most 911 calls in Jersey are answered by volunteers.. People who care about their patients and community. You guys could learn from us!
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Did you ever think that what you just said here is the reason your state is so backwards with its EMS system.
 
Let's stay on topic folks. The volunteer vs. career debate has been done to death.


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RobertAlfanoNJEMT said:
That is fine with me, stay in Texas! Most 911 calls in Jersey are answered by volunteers.. People who care about their patients and community. You guys could learn from us!
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You're joking right?
 
I'm now getting very confused on what an NPA can and cannot do. For some reason I thought it wouldn't help with the tongue problem.
 
RedAirplane said:
I'm now getting very confused on what an NPA can and cannot do. For some reason I thought it wouldn't help with the tongue problem.
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It doesn't. If the tongue is blocking the airway an OPA can keep it out of the way. The NPA doesn't reach far enough to reach the trachea.
 
RobertAlfanoNJEMT said:
That is fine with me, stay in Texas! Most 911 calls in Jersey are answered by volunteers.. People who care about their patients and community. You guys could learn from us!
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I don't mind volunteers. Provided they are held to the same standard as professional EMS providers. In NJ, that often is not the case thanks to the efforts of your <sarcasm>wonderful</sarcasm> first aid council. And as to me being paid detract from my care of patients and the desire to help my community, you need to take a good hard look at why you do this. I live and work in the same community. My neighbors are my patients. It's an island, so everyone is in everyone else's business. If I didn't care for my patients like I would care for my family, I wouldn't last here. Just because I do it as my chosen profession and make money, have great benefits, and will get a quite good pension from it, should not detract in any way from the fact that I've invested almost ten years of blood, sweat, and tears to make myself into the provider that I am. Now, if a maggot like you would like me to stay out of Jersey, fine. My GF is FROM Jersey, and she keeps saying how backwards and screwed up it is, so I wouldn't ever want to go there anyway, even if I was paid and able to live at the same level I do here.
 
RedAirplane said:
I'm now getting very confused on what an NPA can and cannot do. For some reason I thought it wouldn't help with the tongue problem.
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Usually, either one will work. An OPA directly displaces the base of the tongue anteriorly, which will hopefully lift the soft tissue out of the hypopharynx and alleviate the obstruction. An NPA snakes around the superior part of the pharynx behind the tonque to create a route around the obstruction.

IME, a properly placed OPA will usually work better, but an NPA will often do the trick just fine and is usually better tolerated. In reality, you just use whichever one works.

For whatever its worth, the best way to fix passive airway obstruction is to get them off their back. Put them in the "recovery" or "sidelying" (for the nurses) position and the obstruction will very often alleviate.
 
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