Deep Suctioning as Basic

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EMTProject

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Hi everyone so I am a relatively new EMT and had a question about suctioning. From what I understand, deep suctioning is not in the protocol for an EMT basic in Ohio. So my question is, if we are on the road with a patient just getting over pneumonia or who has COPD or any other condition that may cause them to cough up excessive mucus and they are too weak to cough it up what would be the best action? With the hard tip suction you can only go so far into the mouth which wouldn't resolve the issue of deeper mucus that is obstructing the airway.
 
First, a bit of a rant. We spent no time whatsoever discussing deep tracheal suctioning as an individual concept in medic school. Sure, it was briefly discussed is terms of clearing an ETT/trach tube; but not in any sort of detail(insert, occlude, retract, rinse; no more than 10sec suction). In short, I'm only marginally more qualified to perform it than a basic, and 100% of the disparity is due to the increased time spent on airway physiology, not the concept of suctioning; which is completely invalidated if we're talking about maintaining a trach, since the airway is fixed in its orientation. If your entrance point is a tracheostomy and you direct the catheter caudally, its pretty much a no brainer.

I'll let our airway rockstars write the term paper on airway suctioning. All I'll say is that, as a basic in my area at least, you're limited to the oropharnyx with the yankauer; so the patient clears their secretions up that far and you Hoover them out with the rigid catheter. If they need more invasive maintenance, its time to call als. If the patient is unable to maintain their own airway, then they are not appropriate for bls transfer, in my opinion.
 
EMTProject said:
Hi everyone so I am a relatively new EMT and had a question about suctioning. From what I understand, deep suctioning is not in the protocol for an EMT basic in Ohio. So my question is, if we are on the road with a patient just getting over pneumonia or who has COPD or any other condition that may cause them to cough up excessive mucus and they are too weak to cough it up what would be the best action? With the hard tip suction you can only go so far into the mouth which wouldn't resolve the issue of deeper mucus that is obstructing the airway.
Click to expand...
Deep suctioning isn't just stuffing a French catheter down the airway. It needs a guide, and that guide is usually endotracheal tube or trach.
 
Positioning, do what you can with the oropharyngeal auction, call for ALS. That's about all I would do, honestly. I wouldn't be comfortable taking a patient on any decent distance if they aren't able to clear their airway.


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hometownmedic5 said:
First, a bit of a rant. We spent no time whatsoever discussing deep tracheal suctioning as an individual concept in medic school. Sure, it was briefly discussed is terms of clearing an ETT/trach tube; but not in any sort of detail(insert, occlude, retract, rinse; no more than 10sec suction). In short, I'm only marginally more qualified to perform it than a basic, and 100% of the disparity is due to the increased time spent on airway physiology, not the concept of suctioning; which is completely invalidated if we're talking about maintaining a trach, since the airway is fixed in its orientation. If your entrance point is a tracheostomy and you direct the catheter caudally, its pretty much a no brainer.

I'll let our airway rockstars write the term paper on airway suctioning. All I'll say is that, as a basic in my area at least, you're limited to the oropharnyx with the yankauer; so the patient clears their secretions up that far and you Hoover them out with the rigid catheter. If they need more invasive maintenance, its time to call als. If the patient is unable to maintain their own airway, then they are not appropriate for bls transfer, in my opinion.
Click to expand...

This is interesting, we had to do 5 deep suctioning via ET or trach during our hospital clinical rotation in the ED/STICU and "suggested" another 5 during our road time
 
If the patient is too weak to expell the mucus and they are desating despite oxygen therapy and showing signs of distress I would place a nasal trumpet and deep suction down that if they tolerate it. Great for DNR patients, whom are not comfort care, that are obtunded and not clearing secretions. Leave the trumpet in to avoid repetitive trauma of insertion. Although not for a basic, using a little viscous lidocaine makes everything easier.
 
Do the best you can in your skill level. Also, you can hand it to the pt to self auction as needed if they're conscious and alert.
 
As an EMT-B in Los Angeles county I am allowed to deep suction with a French catheter.
 
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