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Crashing airway patient

Discussion in 'Scenarios' started by Rialaigh, Jan 2, 2017.

  1. Chase

    Chase Flight Nurse

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    I have seen a precordial thump work once. The theory is sound, just like commotio cordis. I also like the idea of percussion pacing from the old school anesthesia literature. When I was a floor nurse I had a patient that kept going asystole on me and every time I did a sternal rub/thump his rhythm would pick back up and he would wake up for a few seconds then slow back down. Pretty cool and worked until the crash cart got there.
     
  2. StCEMT

    StCEMT Forum Deputy Chief

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    So when going for the thump...aim for the sternum and hit as hard as you can?
     
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  3. VentMonkey

    VentMonkey Crackpot Premium Member

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    :D
     
  4. FireWA1

    FireWA1 Has no idea what I'm doing.

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    I bet you could even call it a "sternal rub" to make it a bls procedure.
     
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  5. StCEMT

    StCEMT Forum Deputy Chief

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    But isn't that how its done on TV? Be all dramatic, shout "DONT YOU DIE ON ME" and then hit them and they magically come back? Hollywood would never lie.
    That's a damn good rub then. :p
     
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  6. VentMonkey

    VentMonkey Crackpot Premium Member

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    This is essentially what I was taught in school. Placing your elbow over their navel area should "in theory" generate enough force for it to be effective.

    I would agree with an above post regarding its application in perhaps a commotio cordis situation what with the "R on T phenomenon", etc.

    I am willing to bet on the handful of patients it had success on, they were at that rare part in the cardiac cycle, truly divine intervention.
     
  7. bakertaylor28

    bakertaylor28 Forum Lieutenant

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    Really, the way I see this is that, on arrival our major issue is respiratory. In my book, this is one of those situations where methodical comprehensive assessment takes the back seat for the moment and you treat symptomatically to get it on ice to try to avoid the code or at least delay it long enough to come up with a plan. Bottom line, off the top, you pretty well know this situation is probably going down hill, so RSI (perhaps with a king) is your best strategy off the top. We don't really have the time to sit around considering CPAP as an option, and frankly we don't want to be jacking with a BVM either at this point. Bottom line the way I see this is stabilize an airway quickly as possible or deal with the impending code. (would rather avoid dealing with the straight out code). After having secured the airway, I would then be in favor of looking to the more standard assessments and figuring out potential causes.
     
  8. Tigger

    Tigger Dodges Pucks Community Leader

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    This patient needs to be ventilated pretty much immediately. A BVM is going to be needed. And I am not sure I would RSI someone only to place a King tube. This patient needs positive pressure and while a King can do that, there are better options.
     
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  9. Handsome Robb

    Handsome Robb Youngin' Premium Member

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    You're going to precipitate an arrest in this patient by sedating and paralyzingly a profoundly hypoxic and hypotensive patient...


    Sent from my iPhone using Tapatalk
     
  10. StCEMT

    StCEMT Forum Deputy Chief

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    If we were in a rush, my partner and I could have someone on CPAP in a matter seconds, our CPAP set up is pretty easy get ready. Compared to the alternative, I will spare a little time to oxygenate them and try to get their pressure up before intubating.
     
  11. Tigger

    Tigger Dodges Pucks Community Leader

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    This is a good patient for push dose epi, but I don't think that's something most people are cognizant of.
     
  12. bakertaylor28

    bakertaylor28 Forum Lieutenant

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    My reasoning behind not opting for the BVM is because I would expect to encounter significant resistance with a BVM with this type of situation, especially since we're probably going to assume that the most common underlying pathology is most likely going to involve significant edema, etc. in the upper airways essentially. Hence, causing me to immediately consider the ET / King / Combi. (where the king is probably going to be your fastest bet.) And I agree with the notion of the Epi.
     
  13. VentMonkey

    VentMonkey Crackpot Premium Member

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  14. Chase

    Chase Flight Nurse

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    This is why peri-intubation arrests are so common....

    Insert "This is why we can't have nice things!" Meme
     
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  15. Remi

    Remi Forum Deputy Chief Premium Member

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    Sux --> tube --> apologize later.
     
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  16. Handsome Robb

    Handsome Robb Youngin' Premium Member

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    With an experienced competent clinician doing the airway absolutely.


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  17. TransportJockey

    TransportJockey Forum Chief

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    Not a fly by night technician?

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  18. Tigger

    Tigger Dodges Pucks Community Leader

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    Incidentally our medical director now wants us to handle these sorts of "crash" airway patients with a slug of Ketamine (2mg/kg IV), tube, and then handle the rest.
     
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  19. bakertaylor28

    bakertaylor28 Forum Lieutenant

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    Assuming of course Ketamine isn't otherwise contraindicated is the real kicker. I could see Ketamine as an alternative to more orthodox RSI (and perhaps make things a bit smoother in some ways if your particularly adept with dropping an ET or a King) On the other hand, if your case involves the presence of barbs, major tranqs, benzos, alocohol, etc. The ketamine is probably going to end up potentiating CNS depressant effects which probably isn't the best situation in the world, but never the less probably the most manageable solution in the long haul.
    This whole thing almost sounds like one of those mega-code scenarios where things are going to turn into a quite nasty situation regardless of how you really handle it - the question is really more of exactly how long its going to take for the crap to splatter off the fan blades.
     
  20. Tigger

    Tigger Dodges Pucks Community Leader

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    I am not sure that Ketamine potentiates CNS depression.
     

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