Medic38572
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Just corious at what you all think about RSI? What do you see as Pros and Cons of rapid sequence intubation's? Have You ever RSI anyone? What problems did you have?
RSI
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CaptainPanic
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It is a PVC - Challenge..... :lol: 
:lol:
:lol:
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Medic38572
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LOL yes it can be but we can treat that also. 
:lol:
:lol:
Ridryder911
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Actualy, RSI should be considerd as " within normal standards of care" these days. If you trust your Paramedics to adminster medications and intubate and perform advanced airways such as circh, trach... etc... they should be able to perform RSI. With this saying, a detailed course of RSI and close monitoring of TQI on performance has to be in place along with this.
The days of not getting an secured airway should not be tolerated and inproving oxygenation for uncompensated hypoxemia. EMS servies needs to be mature enough to treat patients accordingly.
Be safe,
Ridryder 911
The days of not getting an secured airway should not be tolerated and inproving oxygenation for uncompensated hypoxemia. EMS servies needs to be mature enough to treat patients accordingly.
Be safe,
Ridryder 911
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Ridryder,
some very good points. The issue is, some places have ALS staff that aren't. ummm, the sharpest tack in the box, so to speak. Also, i don't think you should even TALK about RSI until you have "basic" airway skills under control.
We need to be able to use a bag valve mask and not cause gastric insulflation. This is a learned trick, and almost an art form. I've seen too many codes turn into "vomit fests" because someone was WAYYY to excited working the BVM, and ventilated with super high flow, at 50 times a minute.....
I'd like to see RSI drugs on the state ALS drug list, and RSI be an optional skill at the discretion of the Medical Director. If it is allowed, there needs to be a mandatory class, as well as mandatory OR time, and remediation if you don't intubate x times, or you fail at getting the tube on the first or second try y times.
Jon
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Medic38572
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Ridryder,
some very good points. The issue is, some places have ALS staff that aren't. ummm, the sharpest tack in the box, so to speak. Also, i don't think you should even TALK about RSI until you have "basic" airway skills under control.
We need to be able to use a bag valve mask and not cause gastric insulflation. This is a learned trick, and almost an art form. I've seen too many codes turn into "vomit fests" because someone was WAYYY to excited working the BVM, and ventilated with super high flow, at 50 times a minute.....
Jon [/b][/quote]
And jon I agree also. I to have seen the vomit fest but was it actually the increased hyperventilation or was it by not having an open airway to ventilate with(meaning were hand techniques used while using the bag valve mask or was the airway collapsed forcing air into the stomach caused by excitment?
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And jon I agree also. I to have seen the vomit fest but was it actually the increased hyperventilation or was it by not having an open airway to ventilate with(meaning were hand techniques used while using the bag valve mask or was the airway collapsed forcing air into the stomach caused by excitment?[/b][/quote]
Some of both.
If you hyperventilate, and don't let gas escape, the pressure builds and you have air in the stomach, because it has no place else to go
Jon
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Medic38572
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: thumbsup :
Ridryder911
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Hopefully, they will know how to properly ventilate a patient and know proper basic positoning manuevers withSellick manuever to help prevent gastric ventillations form occuring. If they don't know this or do not perform this ....maybe they should not be performig RSI.
be safe,
Ridryder 911
be safe,
Ridryder 911
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Have you seen Dr. Henry Wang's study on how poor PA Medics do with advanced airway management???
I watched two doctors (Hospitalists) RSI the other day in ICU. So you talk about some medics having poor intubation skills. First of all we had a 125 kg male in respiratory distress with RR 40-50 and O2 sats holding around low 90s to high 80s, luckily. These two docs were very slow to put this guy down with meds. He was still having spotanious respirations at a RR of 18 with 150 mg of Diprivan (Propofol), 5 mg Versed, and 10 mg Vecuronium Bromide on board! The first doc tried to intubate three times while holding the laryngoscope with her right hand and cross her left hand over with the et tube. She got esophageal placement x 3. We ended up taking 1 hour and 10 minutes to intubate this guy. He was vomiting due to the length of time we bagged him. Wow! This is why we all have back ups to ET tubes like a Combitube.
ndilley
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whewww....glad i wasn't that pt. was he just a tough tube or were the docs skills less than par?