Does Size Matter?

[Carlos Danger]

By the same token I have never once worked on an ambulance that had BVMs with a PEEP valve. I carry one in my bag of "things the old school medics won't buy for the ambulances."

That’s interesting and unfortunate. I’m pretty sure we had them on my first EMS job in the mid 1990’s and every place I’ve been since then.

 

[DesertMedic66]

That’s interesting and unfortunate. I’m pretty sure we had them on my first EMS job in the mid 1990’s and every place I’ve been since then.

My experience is the same as Tiggers. I have not encountered any agency in my area, except maybe Hall ambulance, that carries PEEP valves.

 

[Tigger]

Sadly my full time job does not have vents either. Even the disposable SureVents we have at AMR can provide PEEP at least. We don't have video scopes either, so I've been using more 8.0 tubes here and honestly have not had any issues with the extra 0.5mm.

 

[VentMonkey]

My experience is the same as Tiggers. I have not encountered any agency in my area, except maybe Hall ambulance, that carries PEEP valves.

To be fair, we only have them at CCT.

@Remi I haven’t seen any in the prehospital environment out here in Cali over the past couple of decades. Maybe it’s a regional thing?...

 

[MSDeltaFlt]

I wanted to ask this question to some of the forums airway heavyweights, @E tank, @Remi, and a couple others whose names escape me right now.

Simply put: Does the size of an ETT relative to an adult patients size truly matter?

The reasons I ask are A) the last few inductions that I’ve participated in I’ve asked for an ETT only to find myself on the receiving end of a standard 7.0 with otherwise healthy adult males. Both of which were corrected with an 8.0 and a look by the ground crews as if this was being done punitively.

I assure you this is not what I was taught, nor how I have learned to evolve my thought process regarding proper airway management.

And B) to my understanding, the wrong sized ETT is often replaced with the right sized one (i.e., the appropriate size for the patient at hand barring any anatomical challenges). Why cause double the risk or harm?

Is it really being skimmed over in the majority of paramedic schools that “hard plastic” is all that matters, but not the proper size for right reasons to include airway pressures, and resistance met on ventilators and such?

Anyhow, as usual all comments and opinions are welcomed. I figured the CC subforum could use a bump. And yes, the thread title is absolutely click bait.

With the advancement of powerfully and technologically advanced microprocessor ventilators, the size of the ETT is pretty much made moot. There were days when it was a major concern with T-piece trials. Yes I am that old. Took me forever to figure out how to hook up an H valve on my MA-1 for weaning. But those days are pretty much gone the way of the Dodo.

But as for me, my personal preference is "if it'll fit it stick it". And I use that philosophy for adveolar recruitment. Laminar flow is better that turbulent flow. The lowest possible PIP's are always better. Not to mention utilizing the least amount of air to fully inflate to cuff (3-5cc) for minimal leak is always beneficial as well. I love 9's and 10's. But I'm also not stupid. If all I can get is a 7, I'll drop a 7.

Trach's tend to be larger in diameter than some might realize. Go big. Have a one size smaller as a back up right beside it just in case it won't fit.