Drowning victim code and ROSC

[bonedog]

Wasn't there, seems like the evidence given was missing some patho/licensure...

Hyoid distance, jaw and neck mobility, ability to open mouth, can all point towards possible adjuncts and pathways.

If the first attempt didn't work hopefully they tried different angle's/alignment, bougie etc.....

Personally my initial training was OR with many different anethestitists and our system is targeted (or was prior to the dreaded MPDS) so have yet to use a surgical airway(have been taught two)

A buddy of mine was mentoring an ALS from a different system who related she had done three surgical airways on CHF patients? He told her in his career, 30 years, he had never done one......if you get the tube you don't need the knife.

 

[usafmedic45]

Hyoid distance, jaw and neck mobility, ability to open mouth, can all point towards possible adjuncts and pathways.

It's more for the "Visualized" vs "Non-visualized" vs "Oh, he's doing OK with us bagging him, so let's not cause any more problems than we already have" decision tree.

A buddy of mine was mentoring an ALS from a different system who related she had done three surgical airways on CHF patients?

Come again? Someone needs to have some remedial training at a minimum.

If the first attempt didn't work hopefully they tried different angle's/alignment, bougie etc.....

What concerns me is the failure to get an LMA placed which is more often a result of unfamiliarity with it (read as: lack of practice) than something up with the patient assuming no gag reflex. Like I said, the goal is to oxygenate and ventilate so the presence or absence of an invasive airway should be considered secondary.

 

[bonedog]

Come again? Someone needs to have some remedial training at a minimum.


Exactly, different province, different system....

 

[FLEMTP]

If the guy was big enough, and the hands small enough... why not go for a digital intubation? I have large hands, so ive only been able to do it a "hand"ful of times (sorry i had to lol) but if you cant visualize the cords, you can certainly attempt to palpate the epiglottis and pass the tube that way...

Also, this is a situation maybe the SALT airway could have been used... our agency is using them on a trial basis, but I think they are going to be implemented county wide soon, they've worked out quite well here.

 

[bdraft73]

check this out

to: seekerof the truth


I read your threads on NWFdailynews.com

and now im reading your threads on this website. my understanding after doing my home work is that your a new EMT and a volunteer fire fighter for a dept in my area. You dont know a whole lot about ALS. CPAP isw contraindicated in unconcious pt's. Obviously ever body has already told you this..even emt's that have been on the job for a few months knows this. and know you are saying crap bashing union fire fighters because obviously you cant get a paid job as a firemedic of a fire emt for that matter. Now that we all know who you are you never will. We know how you are and what your name is and what rig you work on so as of now you are black listed. If you dont know what that means please ask your partner im sure she will gladly explain what that entails. So do your homework next time before you start spouting off and making a fool out of yourself and bashing union firefighters. I once too was a volunteer firefighter abut now i am pround to say i am union. Im sure you boss will love to hear all about your bashing of the local fire depts and the local ER doctors you work for. I'll be supprised if you have a job this time next month with that attitude of yours.

 

[bdraft73]

cold water what?

Oh and for i forget, this is florida, the water temp here is now in the 70's and not considered a cold water drowning. RSI or just plaing tubing the pt is the only definative choice of airway control, next to just bagging them that AHA recommends. SO write AHA next time you have a conflict with what you think is right in protocol.h34r:

 

[seekersofthetruth]

Hey bdradt. I didn't make that post on the daily news website. I had already gone and thouroughly apologized to the station for this post getting out and someone posting it on that website. This was my first post on this website and probably my last since someone decided to do that. I have never applied for a fire job here. I actually like the fire departments I work with. The reason behind this whole thread was just to try to learn from. Like I said I already went to the station and apologized to them for the link getting out and that guy "jakeemtp" posting the link. I don't really know what more I can do to make things right. I tried to get this thread deleted several times along with the one on the daily news site.

 

[18G]

Bdraft73.... what exactly did seekeroftruth do wrong or out of line? All he did was post a call he responded to and asked for feedback. What crime is there in that? Granted, he came off with some wrong suggestions to treatment approach but he is obviously a new EMT. Posting on a message forum and receiving feedback is a awesome way of learning from very experienced people! I think the responses his post generated were very enlightening to seekeroftruth.

Maybe I'm missing something or there is more to this than seems apparent, but he really didnt do anything wrong. There was no mention of providers names, no reference to departments, unit#'s, etc. It was a very general post. People are allowed to have opinions. So what if he didn't agree with what happened on the call or thought it could have been done differently. You don't ever feel that way on calls?

Perhaps you should use this as a teaching moment so when he encounters a scenerio in the future he will be able to approach it differently and with a different thought process.

Coming off as an *** and condescending is very counter productive don't ya think. And "black listing"? Really? Over a very generalized post of a call on a message forum? Sounds really overzealous to me.

Seekeroftruth... don't be intimidated... keep posting and asking questions.

 

[usafmedic45]

CPAP isw contraindicated in unconcious pt's.

It is not contraindicated in unconscious patients. It is contraindicated in patients who are not maintaining their own airways and ventilating on their own. There is a big difference. If it was contraindicated in all unconscious patients simply because they are unconscious, then it's primary use (amelioration of obstructive sleep apnea) would be impossible. Before you start bashing someone for not knowing something, make sure you have your facts straight.

even emt's that have been on the job for a few months knows this.

Actually a lot of EMTs and medics don't know this. I've encountered doctors who are just as clueless.

So do your homework next time before you start spouting off and making a fool out of yourself and bashing union firefighters. I once too was a volunteer firefighter abut now i am pround to say i am union.

This isn't a debate about union vs. non-union and I'll thank you kindly to keep it that way.

RSI or just plaing tubing the pt is the only definative choice of airway control, next to just bagging them that AHA recommends.

Wrong again. You can establish a definitive airway in several ways (surgical airway, Combitube/King airway, LMA, etc). All of these methods are used in operating theatres as "definitive airways" on a daily basis. The fact that EMS personnel have it drilled into their heads that either it's ETT or it's not "definitive" is a sign of how poorly educated a lot of us are.

next to just bagging them that AHA recommends.

Actually bagging someone is not a definitive airway in the technical sense since it still allows aspiration to occur.

Im sure you boss will love to hear all about your bashing of the local fire depts and the local ER doctors you work for. I'll be supprised if you have a job this time next month with that attitude of yours.

As if your attitude is much better? You've proven you don't know the facts underpinning your job any better, that you have an ego way above what is justified based upon your demonstrated knowledge and you seem to be abusive to your colleagues when you are not certain whether they did something wrong or not.

Seekeroftruth... don't be intimidated... keep posting and asking questions.

What he said...every forum has their ******s and apparently we gained another one. Please stick around and learn from those of us who want to teach and not simply bash people and make crap into false divisions (union vs. non-union, paid vs. volunteer, etc).

 

[reaper]

It is not contraindicated in unconscious patients. It is contraindicated in patients who are not maintaining their own airways and ventilating on their own. There is a big difference. If it was contraindicated in all unconscious patients simply because they are unconscious, then it's primary use (amelioration of obstructive sleep apnea) would be impossible. Before you start bashing someone for not knowing something, make sure you have your facts straight.



Actually a lot of EMTs and medics don't know this. I've encountered doctors who are just as clueless.



This isn't a debate about union vs. non-union and I'll thank you kindly to keep it that way.



Wrong again. You can establish a definitive airway in several ways (surgical airway, Combitube/King airway, LMA, etc). All of these methods are used in operating theatres as "definitive airways" on a daily basis. The fact that EMS personnel have it drilled into their heads that either it's ETT or it's not "definitive" is a sign of how poorly educated a lot of us are.



Actually bagging someone is not a definitive airway in the technical sense since it still allows aspiration to occur.



As if your attitude is much better? You've proven you don't know the facts underpinning your job any better, that you have an ego way above what is justified based upon your demonstrated knowledge and you seem to be abusive to your colleagues when you are not certain whether they did something wrong or not.



What he said...every forum has their ******s and apparently we gained another one. Please stick around and learn from those of us who want to teach and not simply bash people and make crap into false divisions (union vs. non-union, paid vs. volunteer, etc).

:beerchug: