Pausing for the tube

wiggy762 said:
...that somewhere around 100+ successful intubations allows some sort of experience-based authority. At this number, the Medic has a good amount of experience with the other than normal airways.

Like I said..."YMMV" (Your Mileage May Vary);)

I apologize if I ruffled some feathers.
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The average paramedic in the United States will have fewer than 100 intubations under their belt at the end of their career, so clearly it is your mileage that varies.
 
usalsfyre said:
Not to be rude, but...

The way to protect against aspiration is to prevent aspiration. The tools to do that are a gastric tube, either NG or OG, placed as soon as conviently possible, and good oral care in the form of suction. They can both be performed with a ETT or King in place (granted oral care is tough). Thousands of cases of VAP will disagree with you on the aspiration protection offered by ETT, and an ETT placement does nothing to deal with gastric distension that may have occured PTA. Although it's entirely conjecture, I'll bet a King/OG tube combo will do as much (or more) to protect against aspiration as a ETT alone. Remember that airway protection and intubation are not one and the same.



I've done around 100 intubations (stopped counting a while ago) and about 30 King placements. I'm not anti ETT, but unless services are willing to provide the oversite and training needed, and individual medics are willing to devote the time master airway control (not just intubation) then LMAs or Kings/Combis are the only thing that should be allowed.
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I agree with everything you wrote, right up until the last sentence. There are times when an ETT is needed and nothing else will do. For a system to totally do away with ETT is asking for trouble. I agree that on an arrest, a King would be my first choice. They are excellent designed airways and provide ventilation without problems. But, there are still times when an ETT is needed or you will end up losing that airway.
 
reaper said:
I agree with everything you wrote, right up until the last sentence. There are times when an ETT is needed and nothing else will do. For a system to totally do away with ETT is asking for trouble. I agree that on an arrest, a King would be my first choice. They are excellent designed airways and provide ventilation without problems. But, there are still times when an ETT is needed or you will end up losing that airway.
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Completely agree. There are times when an ETT is the only intervention that will work, just like there's times when only a surgical airway will work. I don't wish to see these interventions taken away at all...

...BUUUTTT....

..at some point writing protocols becomes a numbers game about doing the most good for the most patients. Unless a particular system is vigilant about proficiency and QA/QI of ETTs (especially if RSI is used), my bet is a far larger number of patients will be helped by taking layrengoscopes out of "Mongo the Cavemedic's" hands than the few cases where an ETT is the level of airway needed.
 
In our protocolls we are not allowed to stop cpr. First advanced airway tools is the larynxtube (kingtube) if this not work we use the glide scooe for ETT (don't forget the NG and OG tools. I often use them in the operationsrooms).
If you can't intubate and have a bad ventilation you can stop CPR for your airway management NOT LONGER FOR 30sec., but there not many patients with mallampati grade 3-4. In opinion in most of the cases the kingtube works good during cpr :unsure:
Matt
 
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Wasn't Wiggy off Laverne and Shirley? And wasn't that on in the SEVENTIES? :D
 
That was Squiggy....

...but I am from the way back.:D

Was practicing EMS in the 80's.
 
70s.? You mean they had wheels and ambulances back then?!
 
Never paused for placing an ET tube in during a cardiac arrest, I get someone to hold Cric pressure & make sure everything is in order before I begin & then it takes less than 10 secs to get the tube in place. The only time I pause compressions is to check for breath sounds after the tube is in place...then compressions start back immediately...and my ETCO2 detector is placed.
 
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