I used SEARCH and no dice: trans-tracheal meds

[mycrofft]

I remember first hearing about trans-tracheal meds during resuscitations in the late Seventies/early Eighties, it was touted as being so much, much better than other routes because it had such a huge absorptive bed (trachea/broncheal tree/alveoli)...then, nothing., at least in the shallow water I've been in.
Are meds still commonly injected through the tracheal wall and/or just injected into the lumen of the tracheal tube airway, or is the parenteral route still the most common, as my experience seems to bear out?

 

[TatuICU]

I remember first hearing about trans-tracheal meds during resuscitations in the late Seventies/early Eighties, it was touted as being so much, much better than other routes because it had such a huge absorptive bed (trachea/broncheal tree/alveoli)...then, nothing., at least in the shallow water I've been in.
Are meds still commonly injected through the tracheal wall and/or just injected into the lumen of the tracheal tube airway, or is the parenteral route still the most common, as my experience seems to bear out?

Pretty sure ET administration, while still "acceptable", is frowned upon. Never understood it myself, it sucks. Once again, another issue where theory and actual practice seem to diverge on the issue of efficacy.

 

[Brandon O]

Down the tube is considered inconsistent, unsupported, and slow time-to-effect. Very discouraged now; see the latest ACLS.

 

[MSDeltaFlt]

90% moot point from I am. IV/IO, unless they're BAKA and I can't get IV, then I'd go ET. Trans-tracheal is superfluous IMHO.

 

[jjesusfreak01]

90% moot point from I am. IV/IO, unless they're BAKA and I can't get IV, then I'd go ET. Trans-tracheal is superfluous IMHO.

I just gave myself a brownie point for knowing what BAKA means. Why no love for humeral IOs?

 

[MasterIntubator]

NAVEL-G is the acronym we used to use back in the day. Narcan, Atropine, Valium/Versed ( water based versions only ), Epi, Lidocaine and Glucagon.

That route these days are a last resort option in a person who has brittle bone disease without arms and legs, no central line and poor jugular access.

Although... epi 1:10,000 down the tube has worked well improving compliance in an intubated young adult who coded due to asthma. Given the scenario again, I would give it another whirl. Tis about it though....

 

[Handsome Robb]

I just gave myself a brownie point for knowing what BAKA means. Why no love for humeral IOs?

Only our flight medics and RNs can use the humoral head but hopefully that is going to change with the next protocol review, maybe even the sternal site but it seems like it would be impractical since IOs are generally only used in codes and rarely for patients who are in extremis.

We are allowed to use ET route for administration in the presence of cardiac arrest when there is no possible way to gain access but we have to exhaust all options first.

I've never heard of anyone actually giving drugs down the tube in the system I work in.

 

[MSDeltaFlt]

When I was flying I'd drill the arm in heartbeat. But on the ground the state thinks I'm stupid and am only allowed to drill the leg. Which makes absolutely no sense.

Mississippi is the fattest sate in the union (a statistic, BTW) with some of the highest rates of diabetes, CVA, MI, PAD, PVD, & ESRD. Very frequently we'll pick up a pt with BAKA, on hemodialysis, and no port giving us only 3 sites to stick for IV.

Granted every state and every region has the same pt demographics, but that's the predicament we here in this state face on a daily basis.

 

[mycrofft]

Maybe the mask nipple is a fossil. Manufacturers seem to slap any mask they can with a bag-valve, and if not there, then into a pocket mask carrier.
The lumen of the inflation-end (versus patient-end) is uniform. Probably one more example of standardization forced onto suppliers by NATO supply specs in the Cold War; if you didn't meet the spec, you lost out on the contract.

 

[Christopher]

You can use trans-tracheal lidocaine to anesthetize the vocal cords during awake intubation. It can be helpful in nasotracheal intubation as it may help suppress their cough reflex.

Coupled with spraying lidocaine in the posterior pharynx you certainly could anesthetize the patient against their gag reflex as well.

Obviously a bit outside our scope, but worth knowing