Rapid Sequence Airway

[boingo]

The leading cause of morbidity and mortality in surgical airway is the failure to perform it.

 

[usafmedic45]

Well said, although if you don't mind me modifying it just a bit:
"The leading cause of morbidity and mortality in surgical airway is the failure to perform it in a timely fashion".

 

[boingo]

Works for me.

 

[Veneficus]

Should we be doing RSI with non-visualized airways? The answer is....maybe.

I am not so sure I agree with this, but have not made up my mind.

Can you tell me under what circumstances you could invision the need to paralyze somebody in order to use a supraglottic airway would outweigh the hazards associated?

 

[usafmedic45]

Can you tell me under what circumstances you could invision the need to paralyze somebody in order to use a supraglottic airway would outweigh the hazards associated?

I'm not saying it's necessarily a great idea, just pointing out that if we are strictly working from the anesthesia roots of RSI as we know it, then the use of a supraglottic airway is not necessarily too far from an acceptable practice. Most likely it would be theoretically beneficial in those scenarios where you need to paralyze the patient for their protection more than for strict airway control (head injury as an example) and yet have something that is going to bode towards this being a difficult intubation (bull neck, facial trauma, etc).

Of course, the best solution is to fix the real problem (stupid providers) and not simply pull skills away that are potentially beneficial (intubation and RSI). Fix the system for using the tools, not the tools.

 

[M3dicDO]

use of a supraglottic airway is not necessarily too far from an acceptable practice.

I agree. The use of supraglottic airways is not an inappropriate way to manage an airway by any means. One thing that needs to be considered is the fact that these airways aren't the best choice for transport settings. Maybe it's the Chicago potholes or the "Windy city" turbulence talking, I've always tried my best staying away from supraglottic airways. It is a valid option nonetheless.

Someone previously asked about using paralytics with supraglottic airways, and it's not a bad idea.....in an OR. There are no set rules in clinical practice on airway management, especially if you're an advanced provider dealing with a difficult airway. You can have protocols that cover challenging patient scenarios very extensively, but it will all go out the window when you are sucking up the seat cushion. Your training and experience is your best asset in coming up with creative solutions to some of the most difficult cases.

Fix the system for using the tools, not the tools.

Couldn't have said it better myself. Mind if I use this quote sometime? Seems like you guys in Indiana have the same problems we do. Must be the wind currents....

 

[usafmedic45]

Maybe it's the Chicago potholes or the "Windy city" turbulence talking, I've always tried my best staying away from supraglottic airways. It is a valid option nonetheless.

You use LMAs don't you? Honestly between a Combitube and an ETT over pothole ridden roads, my money is on the Combitube staying put much more steadily.

Mind if I use this quote sometime?

Not at all.....just attribute it to "Steve".

Seems like you guys in Indiana have the same problems we do. Must be the wind currents....

....and then some.

Do you know why Crown Point is so windy? Because Chicago blows and Indianapolis sucks.

(I actually like Chicago and we're debating moving there).

 

[M3dicDO]

You use LMAs don't you? Honestly between a Combitube and an ETT over pothole ridden roads, my money is on the Combitube staying put much more steadily.

We don't have Combitubes :sad: Only LMAs and King airways.

I've had good experiences with the King airway though, it stays put really nicely.

Do you know why Crown Point is so windy? Because Chicago blows and Indianapolis sucks.

LMFAO!:lol: So you work around Crown Point? What's your opinion on St. Anthony Medical Center? One of the residencies I'm interested in rotates through there.

 

[usafmedic45]

So you work around Crown Point?

Nah, I'm stuck in Indy for the next few weeks then we are heading to Chicago.

 

[281mustang]

I suppose if you are going with the cric option you are already at plan d and unless you really messed up your reasoning for it's use, it's clear sailing from there. I actually found a great video the other day of a doctor giving a lecture on various aiway issues and he had someone actually cric him. It was the damndest thing I have ever seen. I think the presentation was concerning intubations, crics etc when patients are awake. I just could not believe it.

Link?