Gastric distention

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Hey all, just random musings about something that is as common as the morning dew and that is gastric distention in working full arrests. Back in the day when we had positive pressure 'demand valve' regulators (aka Robert Shaw resuscitators), we'd just chalk up taught bellies to those. So because of that, they were taken out of use. Turns out we blow oxygen into the stomach with bvm's just as well. So here's the question. Are there systems that consider placing an OGT to decompress the stomach to mitigate the potential effects on resuscitation? Two things right off the bat would be an impediment to venous return to the heart (and blood pressure and cardiac output) and impeded pulmonary expansion, especially problematic in someone that is at very high risk for aspiration.

Even in ERs and trauma rooms, OGT's are almost an after thought when the patient is resuscitated and on a ventilator. Would like especially to hear from you educator/training folks...
 

Tigger

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We place them through most every igel that gets used on cardiac arrests.

I find that many of our medics were not trained to place OGs when they intubate, which can be more challenging, especially with chest compressions ongoing. When we had NG tubes this was less of an issue but those got removed from the guidelines for reasons not understood.
 

Aprz

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I didn't start doing it until my new job a year ago. At my prior job, it wasn't in our scope of practice or something we carried.
 
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Here's another question...what size OGT on an adult? For those that do, do you place on suction till the belly goes down? Continuous? (It's even more important, IMO in a pediatron). Not to get too graphic, but these are frequently non fasted patients and several passes with the tube may be necessary to get enough of the gas out of the stomach...

I suspect that NGT's are out of favor because of the number of people on blood thinners and the blood bath that can result by dragging a tube across the nasal mucosa.
 

Tigger

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We only carry up to 18fr so that’s what I use for adults when I intubate. IGel 4 takes a 12, a 3 takes a 10. Both are obviously not great for removing contents but will remove air.

They (hospital) says only suction for a minute at a time, I used to just leave it on until contents stopped.
 

StCEMT

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I admittedly need to be better about it. I have placed them, but I won't sit here and say it's every tube. It'd be better practice for me to get into.
 

Aprz

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Use size 16-18Fr in adults. We don't usually carry all sizes, but only 16-18Fr in our intubation bag. In pediatrics, we use the Handtevy app to guide us. For testing purposes, I just remembered twice size of the endotracheal tube you use eg size 5 endotracheal tube means size 10Fr OG tube.

It's a part of our RSI checklist, but the checklist doesn't say it until the very end. A part of the chestlist says to have equipment ready such as bougie, alternative airway, and endotracheal tube ready. I used to put tape on my personal checklist and write OG on it right by that line. There is a tendency to not finish the checklist once intubation is done. There is also a tendency to say "do it during transport" and not do it. If I have it out and ready with the rest of the equipment, with the bougie, alternative airway, and endotracheal tube, then it'll get done.

To be honest, I think we usually cap it after it's placed and don't do anything else with it. I've only used it to suction once and stuff was actively pouring out of it and the patient's mouth before suctioning.

I've only placed it in one arrest. Where I work, it's not common for us to be dispatched to cardiac arrests. All the other patients I've put it in were patients we sedated and paralyzed.
 

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Dodges Pucks
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I also think we struggle with OG tubes given how we teach paramedic students to not let go of the tube until it is secured. It was a fatal offense in my program and with my preceptor to let go of the tube even for a moment before it was secured in a commercial holder. As such, everyone here is like "tube's good, get that thing tied down," and then obviously people are uncomfortable with removing the tube tie to put an OG in.
 

Carlos Danger

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I remember being told in my anesthesia training that the research does not support routine OG placement post-intubation, and that there was actually some evidence that it could be harmful, especially if placed in such a way that it disrupts the LES while not being deep enough to fully evacuate stomach contents. I've never looked at the research myself, but it makes sense to me that there's no need to place one routinely, especially once the airway is secured. In all my years of intubating I don't recall ever regretting not placing one post-intubation.
 

DrParasite

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I believe king airways have a channel in the posterior of the device that is designed to slide an OG tube it... so once you place the king airway in place, with the OG tube preinserted, you just push it down and it goes where intended.

Never seen it done with intubation though
 
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I remember being told in my anesthesia training that the research does not support routine OG placement post-intubation, and that there was actually some evidence that it could be harmful, especially if placed in such a way that it disrupts the LES while not being deep enough to fully evacuate stomach contents. I've never looked at the research myself, but it makes sense to me that there's no need to place one routinely, especially once the airway is secured. In all my years of intubating I don't recall ever regretting not placing one post-intubation.
Don't disagree, just considering those post arrest patients that look pregnant after the resus....
 

Carlos Danger

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Don't disagree, just considering those post arrest patients that look pregnant after the resus....
Oh yeah, you are definitely right about that. I was responding more to the idea that everyone who is intubated should have one placed, which I've heard argued by EM and EMS folks before and never agreed with.
 
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