Scope Expanded to Combitube

[Shishkabob]

I would recommend learning it. I've been told numerous times to drop a combitube during a code, while the medic was getting an IV/IO established. And as an EMT-P student, I'd rather have an EMT drop a tube while I'm pushing drugs because that's precious time being wasted if you have an EMT just sitting around and your not pushing drugs, in my opinion.

I'd rather the EMT be doing compressions than toying with the airway.

 

[AtlantaEMT]

I'd rather the EMT be doing compressions than toying with the airway.

I Agree if it is just an EMT and a Medic (or even a medic and medic). If you have other people available (wether a cop, FF, student. or joe schmoe) to do chest compressions, it seems reasonable for a medic to work on the drugs and eletrical therapy, while the EMT secures an airway. Any bystander can maintain ABCs once an OPA and BVM is set up.

 

[Madmedic780]

Yeah I call shenanigans as well on this BS about ETT and BLS. No flippin way that basics can do that.

Here in Oregon they are giving the Advanced EMT's (AEMT) Intubation but all the county protocols are saying Paramedic only.

Oregon Intermediates however (higher cert that AEMT's) can't intubate but can do kings/Combi and OG tubes.

 

[calebsheltonmed23]

I'd rather the EMT be doing compressions than toying with the airway.

If an EMT was intubating, I would completely agree. But it's a combitube. It's pretty much plug n' play. If the first hole does'nt work, put it on the other. Combitube is a BLS skill (atleast in Missouri), and IV's are an ALS skill. If the EMT can do the same thing I could, just with a different device, why would you not have them do it. Have a FF do compressions and you start a line (FF are automatically dispatched for an unconscious/unresponsive in my county). Now if the patient was under 5' or was a ped, of course I would be intubating. It just depends on the patients presentation and who you have with you.

 

[calebsheltonmed23]

Did anyone in school tell you just how much those code drugs actually help?

No. I assume they help a good amount otherwise we would'nt be pushing them. It all depends on the patient, and all the factors (how long they've been down, traumatic or medical, what kind of medical, etc.) right?

 

[usalsfyre]

No. I assume they help a good amount otherwise we would'nt be pushing them. It all depends on the patient, and all the factors (how long they've been down, traumatic or medical, what kind of medical, etc.) right?

:lol::lol::lol::lol::lol:

So new and naive...

Two things have been proven to change cardiac arrest outcomes in primary arrest. Chest compressions (notice I didn't say CPR) and defibrillation. Which bystanders can do. Drugs may help in other specific causes of arrest, but most paramedics aren't educated enough or don't care enough to identity those specific causes and the appropriate agent. Drugs have never been proven helpful in out of hospital arrest. Simply following an ACLS algorithm is not medical treatment, it's throwing $hit against a wall and hoping something sticks.

 

[MrBrown]

Let Brown think ....

During early 1993 it was loudly proclaimed to a group of Advanced Care Officer students that drugs in cardiac arrest have never been proven to be beneficial.

... and now it's 2011 and some still seem to have not gotten the message, although "Advanced Care Officer" is now called "Intensive Care Paramedic"

 

[calebsheltonmed23]

:lol::lol::lol::lol::lol:

So new and naive...

Two things have been proven to change cardiac arrest outcomes in primary arrest. Chest compressions (notice I didn't say CPR) and defibrillation. Which bystanders can do. Drugs may help in other specific causes of arrest, but most paramedics aren't educated enough or don't care enough to identity those specific causes and the appropriate agent. Drugs have never been proven helpful in out of hospital arrest. Simply following an ACLS algorithm is not medical treatment, it's throwing $hit against a wall and hoping something sticks.

I know that compressions and defibs are what mainly make up the resucitation and I thought drugs had a place in resucitation also but I will do research on that and be better informed.

 

[usalsfyre]

I know that compressions and defibs are what mainly make up the resucitation and I thought drugs had a place in resucitation also but I will do research on that and be better informed.

Sorry for my abrasiveness last night, I was pretty well fried by the time I posted that.

Drugs may have a situationally dependent place in cardiac arrest, for instance calcium in hyperkalemia. But the indiscriminate way we push them right now is pointless and probably harmful.

 

[johnmedic]

Drugs may help in other specific causes of arrest, but most paramedics aren't educated enough or don't care enough to identity those specific causes and the appropriate agent. Drugs have never been proven helpful in out of hospital arrest.

Yep.

"There is no evidence to date that routine use of any vasopressor at any stage during management of pulseless VT, VF, or asystole increases rates of survival to hospital discharge. But there is evidence that the use of vasopressors favors initial resuscitation with ROSC."
P. 48 - ACLS Provider Manual - 2006

"Although there is no evidence that giving any antiarrhythmic routinely during cardiac arrest increases rates of survival to hospital discharge, amiodarone has been shown to increase rates of survival to hospital admission.."
P. 49 - ACLS Provider Manual - 2006

 

[johnmedic]

& to address ET Intubation & expanding the skill to EMT-B's: From a recent study published in February from N.C., the numbers seem to speak for themselves.

"The authors found that... individuals with no ETI attempt were 5.46 times more likely to be discharged from the hospital alive compared with one successful ETI attempt. The authors concluded that ETI attempts are associated with negative outcomes in OOHCA."

Source: http://www.jems.com/article/patient-care/prehospital-intubation-cardiac

 

[Shishkabob]

"amiodarone has been shown to increase rates of survival to hospital admission."

"But there is evidence that the use of vasopressors favors initial resuscitation with ROSC."



And honestly, those two right there are enough for me to continue research into the stuff as you can't have more survivals without more ROSC... we just need to find the missing piece, or concede that the ones that don't get ROSC will never get ROSC.

 

[johnmedic]

And honestly, those two right there are enough for me to continue research into the stuff as you can't have more survivals without more ROSC... we just need to find the missing piece, or concede that the ones that don't get ROSC will never get ROSC.

Absolutely, I agree keep pushing them so we can keep up the research. Definitely not trying to say that it's futile.. But I feel like the survival rates to hospital discharge aren't widely known. Medics can have a blind overestimation of ACLS Drugs similar to the high expectations non-healthcare providers have of CPR.

& yeah, I'm sure I could've worded that better.

 

[medic417]

& to address ET Intubation & expanding the skill to EMT-B's: From a recent study published in February from N.C., the numbers seem to speak for themselves.

"The authors found that... individuals with no ETI attempt were 5.46 times more likely to be discharged from the hospital alive compared with one successful ETI attempt. The authors concluded that ETI attempts are associated with negative outcomes in OOHCA."

Source: http://www.jems.com/article/patient-care/prehospital-intubation-cardiac

Well duhhhhhhhh. If they don't need intubated they are probably not as near death as those that do need intubated. :wacko:

 

[calebsheltonmed23]

Sorry for my abrasiveness last night, I was pretty well fried by the time I posted that.

Drugs may have a situationally dependent place in cardiac arrest, for instance calcium in hyperkalemia. But the indiscriminate way we push them right now is pointless and probably harmful.

No worries. The calcium and sodium bicarb are the main ones I've heard/read about for cardiac arrest, so long as hyperkalemia and/or overdose of the certain meds that sodium bicarb can help with is the reason of it. And I thought that epi would help during cardiac arrest because it helps contractility and increases HR, but we really have'nt went over any of the other drugs, so I'm still pretty uninformed about that subject. Thanks for telling about it!

 

[calebsheltonmed23]

Yep.

"There is no evidence to date that routine use of any vasopressor at any stage during management of pulseless VT, VF, or asystole increases rates of survival to hospital discharge. But there is evidence that the use of vasopressors favors initial resuscitation with ROSC."
P. 48 - ACLS Provider Manual - 2006

"Although there is no evidence that giving any antiarrhythmic routinely during cardiac arrest increases rates of survival to hospital discharge, amiodarone has been shown to increase rates of survival to hospital admission.."
P. 49 - ACLS Provider Manual - 2006

Okay. I will get out my ACLS book and start reading about it. Thanks!