n7lxi said:
an NG tube prehospital is not standard or even a majority practice in EMS.
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NG/OG tubes with intubation
- Thread starter Veneficus
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an NG tube prehospital is not standard or even a majority practice in EMS.
jroyster06
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Well that solves that. I suppose we are lucky and have NG tubes in our protocols. I am surprised they aren't prehospital popular. I think they are a great thing to have and I use them regularly.
NomadicMedic
I know a guy who knows a guy.
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rectal administration of ASA
It's not? We place an OG/NG with all tubes. I learned it as a "standard practice".
It's not? We place an OG/NG with all tubes. I learned it as a "standard practice".
Hunter
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Should be... You get ROSC, I mean why not, I understand if you can't stop in the middle of a code to drop an NG tube, but after rosc dropping an ng tube takes 30 seconds.
jroyster06
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Hunter, I use them in codes alot. Usually during my 45 min transport time i find time to do it, ESP if the pt has been ventalated by bystanders or BVM and has gastric distention.
mycrofft
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NG tubes in protocols. Hm. I can say I've seen some abdominal tympany when taking a patient over from less-trained rescuers that tempted me to use a trochar liked a bloated horse.
Any studies?
Any studies?
boerbull
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NGtube is also standard in my protocol, but I must be honest with the short transport times I have, I usually don't do it. No excuse I know especially after using BVM.
DesertMedic66
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NG/OG tubes aren't in my protocols. But then again neither is ped intubation...
I agree they should be.
In fact I think it is borderline negligent not to, especially if you have been bagging prior to a tube with some kind of occlusive cuff.
But as you know, practice is not changed by my force of will.
Smash
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Standard practice in anyone who is intubated. Reduce splinting from distended abdo in the previously ventilated patient and hopefully help reduce VAP from regurgitation.
EDIT: And (possibly because I am a r'tard) they are 10 times harder to get in than the tube was in the first place.
EDIT: And (possibly because I am a r'tard) they are 10 times harder to get in than the tube was in the first place.
Shishkabob
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Standard here. If they have an ET / King, they have a NG/OG tube. Did one 2 weeks ago on my last arrest.
Meh. One place I worked carried them. I placed one only once. Had plenty of tubes, rarely felt the need to place one. Usually busy with other stuff.
Based on this thread, I am doubtful they serve any use other than to make some medics feel superior for using them when others (the majority, most likely) don't.
Based on this thread, I am doubtful they serve any use other than to make some medics feel superior for using them when others (the majority, most likely) don't.
Shishkabob
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You mean besides reducing gastric distension and allowing active direct gastric suctioning?
Just because some agencies are more progressive / aggressive / up-to-times with medicine doesn't mean they're trying to make their field crews feel slightly superior... it means it's medicine, it has a job, it works, and they do it to benefit the patient.
NomadicMedic
I know a guy who knows a guy.
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Transporting an arrest with ROSC always gets an OG/NG. BLS loves to blow those people up like balloons. I also place them in submersion incidents. Ive been unlucky to have more than my share of drownings and I can usually hoover at least a couple of Toomey syringes of Atlantic Ocean out of them.
I don't feel as that that makes me superior. It just means I'm following my agency's standard of care in relieving gastric distention.
I don't feel as that that makes me superior. It just means I'm following my agency's standard of care in relieving gastric distention.
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How is placing an NG tube progressive? I mean, I won't say it is regressive. But, I am doubtful that it is really necessary. It's just something else for you to do. It seems squarely neutral, probably does nothing in the prehospital setting unless there is obvious gastric distention that is actually hindering ventilation (which I'll bet is very very rare).
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They are also required for all ped intubations in ME. I place them on everyone I tube.
mycrofft
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Doesn't nasogastric suctioning require a far less, ENERGETIC degree of suction versus oropharyngeal?
(20-40 mmHg versus 120-150 mmHg).
(20-40 mmHg versus 120-150 mmHg).
This.
IF you have lesser trained individuals bagging patients and blowing up their stomachs to the point that adequate ventilation is difficult, then they either need to A) learn how to properly bag a patient or B) do compression-only CPR and wait for a better trained individual to place a more definitive airway. This is exactly why ACLS has moved away from early airway management - sometimes it does more harm than good.
IF the abdomen isn't distended, there really isn't a reason to drop an NGT.
If you are really wanting to empty the stomach contents, crank it up all the way until stuff quits coming out, and then turn it back down in the 80-100 range. Continuous high suction to an NGT (200-250+) can injure the stomach mucosa. If you're not getting a return, either reposition your tube (frequently they're not in far enough), make sure it's down the right pipe, and if you still get no return, turn the suction down below 100 or off.