How did you learn to intubate?

I've gradually begun to think that medics shouldn't have more than 1 tube attempt for an arrest –if it's no good on the first try, throw in a BiAD, and let compressions continue. Compressions > ventilations, after all.

Interesting link: http://www.jems.com/article/patient-care/study-analyzes-use-eti-vs-king-lt-ds-car

I couldn't get access to the original study, but the basics are at that link. I'd like to see how survival rates compared, accounting for differences in rhythms.
 
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In my opinion chest compressions should never be interrupted for ETI.

Either you can do it with chest compressions or it is time to ventilate by other means. (alternative airway, etc.)
 
I think most times CPR should not be interrupted but some difficult intubation's stopping for 5-10 seconds is needed....
 
EMSpursuit said:
I think most times CPR should not be interrupted but some difficult intubation's stopping for 5-10 seconds is needed....
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But you can get ventilations in without having to stop for an ETT...so why bother? Yes, the ETT is the gold standard airway, but Kings and Combitubes do nearly as well, and are much easier to successfully place.
 
EpiEMS said:
But you can get ventilations in without having to stop for an ETT...so why bother? Yes, the ETT is the gold standard airway, but Kings and Combitubes do nearly as well, and are much easier to successfully place.
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They may not do nearly as well. There is some interesting data coming out that extra-glottic airways may result in worse outcomes.

It really isn't difficult to intubate during an arrest without stopping CPR. Get everything set up and pass the tube if you can whilst CPR is ongoing. If you can't, wait for the brief pause that comes every 2 minutes and pass the tube then. If you still can't, then just carry on with an alternative (or nothing at all)
 
Smash said:
They may not do nearly as well. There is some interesting data coming out that extra-glottic airways may result in worse outcomes.
Click to expand...

Interesting! I'll keep an eye out for that, thanks!
 
For what it's worth we don't intubate arrests unless its a pediatric and we have the option to stay with a bvm and opa for them. Adults get a KING LTD first line and intubation second line if the KING fails but I've never actually seen it fail.

I'm waiting to see if we move away from the KING with the new research out about them.
 
NVRob said:
I'm waiting to see if we move away from the KING with the new research out about them.
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Found a couple studies that might be worthwhile to consider

"A Comparison of the King-LT to Endotracheal Intubation and Combitube in a Simulated Difficult Airway," Prehospital Emergency Care (2009)

King LTs go in faster than the ETT and are successfully placed at a higher rate than ETTs.

(http://informahealthcare.com/doi/abs/10.1080/10903120701710488)

"The laryngeal tube device: a simple and timely adjunct to airway management," American Journal of Emergency Medicine (2007)

Again, King LTs go in faster than the ETT (P < 0.0001). Also, among the paramedics, Kings are placed successfully significantly (P < 0.05) in higher percentage of trials than ETTs.

(http://ems.pgpic.com/pdf/kingairway_airway_management_independent.pdf)

"A pilot study of the King LT supralaryngeal airway use in a rural Iowa EMS system," International Journal of Emergency Medicine (2008)

ETT insertion fails a lot. Kings are easy to use and insertion doesn't fail. Boom goes the dynamite.

(http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2657251/)


Additional thought: if the King LT was provided to Basics, we could be more useful to medics in an arrest situation – medics can handle meds and EKGs while BLS providers do A, B, and C.
 
So why is the ETT the gold standard for airway maintenance, when the King is just as well as easier to us?
 
DrParasite said:
So why is the ETT the gold standard for airway maintenance, when the King is just as well as easier to us?
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I'm gonna ask an anesthesiologist next chance I get (no joke).

Just a guess, maybe it provides better protection from the airway from stomach contents than the King does? Is that plausible?
 
In cardaic arrest I think it extends past pre-hospital and into the hospital where the pt will be put on the vent in the cath lab. Most RSI patients usually need some sort of immediate intervention also (surgery for trauma and CVA for example). I know at our hospitals the goals are to minimize time between initial pt contact by EMS and definitive care (cath lab/surgery). In some cases if we have the necessary interventions done we will bypass the ED and take the pt straight to the cath lab or to CT.
 
The gold standard of ETI has more to do with protecting the airway from aspiration. Look at some of the "uber airway" books and courses and you see the authors (Like Ron Walls.. et al) repeat that King, LMA, Combitube etc. do not secure the airway in the traditional sense and do not prevent aspiration.

I think the best thing that any prehospital provider can do is to evaluate the patient and choose the best intervention for the patient and the situation. The other tools in our airway bag should be mastered as well as the knowledge of when to use them or not use them.

Judgement is the best skill set a field provider can have.
 
EpiEMS said:
I'm gonna ask an anesthesiologist next chance I get (no joke).

Just a guess, maybe it provides better protection from the airway from stomach contents than the King does? Is that plausible?
Click to expand...

Just my speculation, but I think that intubation being the most optimal airway for mechanical ventilation in the hospital, it was just assumed to be optimal outside the hospital.

Which is more and more proving not to be the case.

Not least of which is because of the inability to remain proficent at a skill.
 
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