Shishkabob
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I did an NG tube on an intubated/RSI'd patient yesterday.
HAHAHAHAHA.
HAHAHAHAHA.
NG Tubes and Airway Management
- Thread starter 18G
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In 2008 we introduced a new qualification for our volunteer Ambulance Officers which takes about a year to complete from start to finish. The practice level is now called "Emergency Medical Technician".
Some people moaned it was too long and hard, the reply was very simple; turn in your boots and good luck, it is the expected standard and we will not compromise because you are not willing to complete it.
This is the same as the "take away intubation from paramedics" argument, it would simply fix a symptom of a problem and not address the problem itself.
Manual ventilation is a tricky skill to develop and maintain Brown agrees, however is there no structured clinical education program or Clinical Support capacity within the Ambulance Service for people to maintain clinical competency and address clinical concerns?
Brown thinks perhaps there is a spare airway manakin lurking somewhere on station ... hmm wonder what postage on that would be
Brown thinks perhaps there is a spare airway manakin lurking somewhere on station ... hmm wonder what postage on that would be
Nobody talks about brave men and their proud simulators.
The trouble with all these high tech baby dolls is they are always the same, and anyone can properly ventilate in a classroom or in the station.
It is when the patient is real, the adrenaline running high, eyes on you, and the whole team that depends on your ability to focus and properly perform your part that seperates the men from the boys so to speak.
IN some of the rural hospitals I have seen, even the physicians start to see skills degredation. The monotony also seems to dull the wit as much as the skills.
Nothing against the providers, but it is the nature of the beast. Somebody has to staff those hospitals.
Smash
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That's why I love heroin overdoses. (On road that is) I get everyone (myself included) to have a go at ventilating the patient, which lets the newer people get some real life hands on experience in managing airways and using a BVM in a less pressing situation. As long as ventilation is occuring there is no problem. After we all have had a go, and the patient is nice and well oxygenated and had all that CO2 washed out, they can have some naloxone and be on their merry way. Everyone wins!
usafmedic45
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I like how you feel the need to point out that they are volunteer EMTs when you mention them as though that is the explanation for the lackluster skills. LOL
OP
OP
18G
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And I like how you take my statements out of context and apply your own meaning.
They are volunteer EMT's. They are not paid. And yes, a distinguishment between paid and volly is sometimes necessary. Our system is very rural which doesnt present many opportunities for calls to begin with let alone with they have to work a full-time job doing something other than EMS.
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DO NOT turn this into another paid vs volly debate.
NG tubes are not necessary in ALS. If you think you NEED one because of abdominal distention, then you need to be working on your basic airway management skills (BVM) and learn how to avoid it in the first place. Violating that cardiac sphinter is a BIG DEAL in an unprotected airway.
OP
OP
18G
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I couldn't agree more on good BLS skills to prevent it. HOWEVER, even with the best BLS airway skills there is no guarantee that gastric distention will not be an issue from time to time in certain patients.
It's just nice to have the tools necessary to address patient issues as they arise.
And everyone keeps saying that the NG tube may cause vomiting, or will "violate the cardic sphincter", etc. So what is the alternative? Keep exerting increased ventilatory pressures to compound the problem? Tolerate decreased tidal volume delivery?
When u have a patient who has gastric distention and has poor pulmonary compliance what do you suggest to correct this problem? Great BLS airway management wasn't enough to prevent the distention so now what?
To me its either tolerate the poor compliance and difficult ventilation which predisposes the patient to increased airway pressure and additional distention and increased risk of aspiration, or place the NG tube to improve compliance, tidal volume delivery, and reduce aspiration risks.
If there is a better idea to deal with this problem I'm totally open to hear it.
It's just nice to have the tools necessary to address patient issues as they arise.
And everyone keeps saying that the NG tube may cause vomiting, or will "violate the cardic sphincter", etc. So what is the alternative? Keep exerting increased ventilatory pressures to compound the problem? Tolerate decreased tidal volume delivery?
When u have a patient who has gastric distention and has poor pulmonary compliance what do you suggest to correct this problem? Great BLS airway management wasn't enough to prevent the distention so now what?
To me its either tolerate the poor compliance and difficult ventilation which predisposes the patient to increased airway pressure and additional distention and increased risk of aspiration, or place the NG tube to improve compliance, tidal volume delivery, and reduce aspiration risks.
If there is a better idea to deal with this problem I'm totally open to hear it.
usafmedic45
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The answer is to either train the folks to avoid it or give them an engineering fix to prevent it. Basically, the best option is prevention.
Honestly, once you get to the point of having gastric distention, you're in a very tough situation due to the very high risk of aspiration associated with relieving it.
usafmedic45
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He's stating that if you can't decompress the stomach that they only option you have to is ventilate against more resistance.
OP
OP
18G
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What ^^^^^ said....
8jimi8
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18G. What you are failing to see is that everyone agrees that an NGT can be used to decompress the stomach.
You are out on the very tip of a long thin branch. What all of the argument was about is that you seemed to want to overuse the skill by applying it to too many situations. That is the way I was reading it anyway.
Now you've changed your story midthread and it seems that you are trying to say that all you were asking is for the devices to be available on your unit, just in case.
I think we all agree, yes, you should be able to have an NGT to drop on your patient, should an event arise that predicates the use of that device.
Yes you should be able to have it and use it.
No it should not be used on every patient
And it will never take priority over other airway interventions.
Key point for the entire thread.
OP
OP
18G
Paramedic
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I feel like I have been repeating myself the entire thread. I thought I was clear in the intent and haven't changed my story.
BandageBrigade
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Not to change the topic, but 18G I suggest that you and your service do some research on the different styles and sizes of King tubes available.
I have never felt the need to drop an NG emergently in the field, but I have put them in before leaving the hospital on transfers.
I have never felt the need to drop an NG emergently in the field, but I have put them in before leaving the hospital on transfers.
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usafmedic45
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...or go with what hospital use in kids they can't intubate: the LMA. I've never understood the argument for having a more or less prehospital specific device. The King Airway seems to fit that description. I've seen plenty of Combitubes in hospitals but not Kings.
BandageBrigade
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There is a local hospital here, a small one. They stock Kings in the ER amd LMAs in the OR. Ive never understood it. I was just making the point that there are multiple sizes available, including child. Not promoting any one item.
mikie
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ET Tubes are not the only airway devices Hospitals have & use...