Foaming At The Mouth

Summit said:
Ah... so that is why you needed hyperbarics!
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Totally by luck that she ended up at Memorial Central in the Springs, if she was 17 we would have likely ended up Penrose, which does not have that.
 
chaz90 said:
We carry them, but no one uses them. If I'm at the point of wanting to intubate a conscious and breathing patient, I'd much rather do a standard RSI. My medical director hates nasal intubations, and I have never done one and am completely uncomfortable with the procedure.
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I make sure all new medics are comfortable with NTI. Just like RSI, they are a tool in the box. RSI is not always a good choice or even able to be done. You need to have that back up available to you.

Any medical director that hates NTI does not have a good grasp of airway management. You need to be comfortable in all airway management.
 
reaper said:
I make sure all new medics are comfortable with NTI. Just like RSI, they are a tool in the box. RSI is not always a good choice or even able to be done. You need to have that back up available to you.

Any medical director that hates NTI does not have a good grasp of airway management. You need to be comfortable in all airway management.
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I'm not certain I quite agree with this. Being comfortable and competent in airway management should mean one is capable of using a variety of tools, rescue devices, and adjuncts to manage a patient's airway as is appropriate for them. That doesn't mean I have to be comfortable or familiar with every single airway device or technique that has ever been devised.

I've never used an iGel or many of the dozens of types of video laryngoscopy devices. That doesn't mean that they don't have a role in airway management, certain advantages, or that I couldn't learn to use them effectively, but I would use my preferred techniques over something unfamiliar if I had both in front of me.

Being comfortable in "all of airway management" should mean you have a plan and backups available along with the skill and clinical acumen to know when to proceed to the next step. In my case, I know enough of my unfamiliarity with NTI and have enough other tools available that I don't plan on ever using it barring exceptional circumstances. If I had a compelling argument as to why it would be beneficial in certain patient populations over some other way I had of managing them and had opportunities to learn how to properly place them in live patients, I would be happy to add it to my skill set. As it stands now though, I would be very reluctant attempting it for the first time on a patient in extremis.
 
Great case that is definitely not straight forward. I might have missed it but any idea where to CO was coming from?
 
Absolutely, cool case Tigger, and thanks for sharing.
 
I'm on vacation right now so I won't know till the new year. We suspect the furnace or water heater, the utility room was adjacent to her bedroom.
 
Finally got some followup. It's still unclear if they placed her in the hyperbaric chamber while intubated or just under sedation, but she received three of five intial treamtents. Initial neuro assessment was positive and as sedation was lifted the patient was found to have an "age appropriate fund of knowledge" and something about a snarky 16 year old attitude. The patient continued to suffer from extreme nausea and could not walk farther than 15 feet without vomiting. The patient was given additional hyperbaric treatments and apparently responded well enough to be discharged on a cannula. She'll be followed by her local children's facility in hopes of additional improvement.

We're all pretty stoked on that, needless to say.
 
I understand that CO poisoning will invalidate an SPO2 reading, so good call on immediately placing her on O2. Our team does underground rescue and we've been considering the purchase of a Carboxyhemoglobin oximeter (SPCO) device. Does anyone have a recommendation for something that isn't thousands of dollars and is relatively portable? I understand a lot of fire services have these for use in the "rehab" area during a fire.
 
meatanchor said:
I understand that CO poisoning will invalidate an SPO2 reading, so good call on immediately placing her on O2. Our team does underground rescue and we've been considering the purchase of a Carboxyhemoglobin oximeter (SPCO) device. Does anyone have a recommendation for something that isn't thousands of dollars and is relatively portable? I understand a lot of fire services have these for use in the "rehab" area during a fire.
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Is there anything other than a rad-57?
 
DEmedic said:
Is there anything other than a rad-57?
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As far as I can tell only Masimo makes such a device.
johnrsemt said:
Didn't see it on first or follow up posts: was her skin flushed?
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Not in the slightest.
meatanchor said:
I understand that CO poisoning will invalidate an SPO2 reading, so good call on immediately placing her on O2. Our team does underground rescue and we've been considering the purchase of a Carboxyhemoglobin oximeter (SPCO) device. Does anyone have a recommendation for something that isn't thousands of dollars and is relatively portable? I understand a lot of fire services have these for use in the "rehab" area during a fire.
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I don't think the NC did much good, but the ET tube certainly helped as per the SpCO on the monitor. That's a 40k device though and not practical for your uses.
 
I understand that the half-life of CO in the body is approximately halved once the Pt. is breathing 100% O2. When we go into mines, one of our protocols is that we must have at least 1 hour of high-flow O2 available and radio, phone or satphone contact with our dispatch from the entrance. We also have two 4-gas monitors with each team.

A lot of old mines have experienced fires at some point, and it is possible that we could open a door and release a trapped pocket of smoke/gas, or discover that something had burned more recently than estimated. The SPCO wouldn't change my treatment, but might help with decision to call for air transport to a hyperbaric facility.
 
Great case, OP. Thanks for taking the time to share this one!
 
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