Scope of Practice(Combi Tubes)?

[usalsfyre]

Our basics can do Kings, and I regularly have them do it. They can drop a King while I'm doing an IO and first responders are doing high quality, uninterrupted chest compressions. It works well.

 

[TransportJockey]

NM allows Combi, King and LMA for basics

Last I checked (which has been a bit) the whole catagory of supraglottic airways is in there since I believe there is one volly service that still has a stock of EOAs

 

[EMS/LEO505]

Lol, idk....Mike is only teaching us those 3 haha ^_^

 

[TransportJockey]

Lol, idk....Mike is only teaching us those 3 haha ^_^

Really the ones you're most likely to come across in the field are the MLA and King. LMAs aren't carried too often in NM anymore on trucks, and the EOAs really really need to die already.

 

[medicRob]

Really the ones you're most likely to come across in the field are the MLA and King. LMAs aren't carried too often in NM anymore on trucks, and the EOAs really really need to die already.

LMA stands for "Let me aspirate" as far as I'm concerned, just sayin..

 

[MrBrown]

LMA stands for "Let me aspirate" as far as I'm concerned, just sayin..

I am kinda inclined to agree, however that said LMAs are working well within our system at all levels. They are an easy skill to become proficent at especially for Technicians but there is still a little resistance at Intensive Care level.

From this year if an LMA is in place and working well we are actively discouraging the practice of changing it to an endotracheal tube however if the patient will not tolerate it snd is unable to maintain an airway we should be requesting an RSI trianed Intensive Care Paramedic or Doctor

 

[usalsfyre]

LMAs...

LMAs are approved for short term airway control in an NPO patient. Anything else is an off-label use. That said, this is the exact same way a King airway is approved. The problem with LMAs (and most standard supraglotic airways) is they leave no way to evacuate the stomach and clear the upper airway of debris. Leaving the patient at risk for aspiration when those substances inevitablly make their way past the airway and get blown into the trachea. I am interested to see how the new LMAs with the NG tube port work.

I will say I have seen far less problems regarding placement with the Kings than LMAs (fairly extensive experince with both, for EMS anyway), as LMAs are a little tricky to place. A key factor all around is making sure you adaquately suction prior to placement, and lubing ONLY where the manufacturer suggest. What we really need is an anesthetists to give us a real run down on which is better.

The intubating LMAs on the other hand, are pure, unadulturated awsomeness...

 

[emtJR86]

Michigan still allows it, and in 2013(i believe), we are dumping the NR, due to these very issues

 

[usalsfyre]

Michigan still allows it, and in 2013(i believe), we are dumping the NR, due to these very issues

emtJR86, I recently came across an article about Michigan and NR, which basicly was focused around FDs whining that their inhouse medic programs would no longer be allowed to test NR due to accredidation issues. Meaning they would have to send their employees to an outside program. I'm betting this has FAR more to do with MI dumping NR than any easily corrected state vs national scope/educational issue.

 

[emtJR86]

emtJR86, I recently came across an article about Michigan and NR, which basicly was focused around FDs whining that their inhouse medic programs would no longer be allowed to test NR due to accredidation issues. Meaning they would have to send their employees to an outside program. I'm betting this has FAR more to do with MI dumping NR than any easily corrected state vs national scope/educational issue.

Not sure...we brought this up the other night in class...not really sure about the FD issue. I know that we have alot of very Rural areas that cannot afford Paramedics, therefore Michigan is looking to expand the Scope of Practice for EMT-I and EMT-B

 

[mikie]

Would it even matter that pt. has an latex allergy? Since they're probably coding any...

or would this just exacerbate it?

 

[himynameismj]

Thought the King was pulled from most places in the US because the FDA found that it wasn't approved for prehospital use.

This is the only secondary device my sponsor uses. I got to use it for the first time today. It is really an awesome piece of equipment. PTL on the other hand, blah.

 

[BSI]

In Indiana we are still allowed to use any non-visualized airways (Combi-Tube, King, LMA, etc.). I know the the commission is considering using the national standard for basics, however to the best of my knowledge it is just a consideration. All of my services basic trucks carry them. I also have an Illinois license, and they are not allowed in that state at all for basics.

 

[medicRob]

LMAs are approved for short term airway control in an NPO patient. Anything else is an off-label use. That said, this is the exact same way a King airway is approved. The problem with LMAs (and most standard supraglotic airways) is they leave no way to evacuate the stomach and clear the upper airway of debris. Leaving the patient at risk for aspiration when those substances inevitablly make their way past the airway and get blown into the trachea. I am interested to see how the new LMAs with the NG tube port work.

I will say I have seen far less problems regarding placement with the Kings than LMAs (fairly extensive experince with both, for EMS anyway), as LMAs are a little tricky to place. A key factor all around is making sure you adaquately suction prior to placement, and lubing ONLY where the manufacturer suggest. What we really need is an anesthetists to give us a real run down on which is better.

The intubating LMAs on the other hand, are pure, unadulturated awsomeness...

Don't get me wrong, LMA's are great when you are in a nice, air conditioned, climate controlled, well-lighted surgical suite, but in the street they are $@!%.

I am really liking the SALT airways.

 

[reaper]

Don't get me wrong, LMA's are great when you are in a nice, air conditioned, climate controlled, well-lighted surgical suite, but in the street they are $@!%.

I am really liking the SALT airways.

We tried the SALT airways out about 3 months ago. After one month on the street and not a single use, that did not have problems, the rest were returned. We ended up with the King LT. I was happy for this. I have used the King LT for 5 years and have never seen one fail. The SALT is a great idea, that just was not designed correctly.

 

[usalsfyre]

Never used the SALT, but a similar option does exist with the King LTS-D and the LMA, as long as you have a bougie available. Pass the bougie down the bore of the airway, it should emerge at the larynx. Pass the bougie as normal, remove the LMA/King and pass the tube. Confirm via standard methods, plus direct visualization if needed.

 

[mikie]

I also have an Illinois license, and they are not allowed in that state at all for basics.

I Worked in Peoria, IL...placed a few Combitubes in my day as a basic (07-09). Recent change or something?

 

[Lucy212]

I'm not sure...

I just finished my EMT course and i never even heard of a combitube or king. What are those?? (Im in CT)

Lampnyter,

I was wondering the same myself. We didn't speak of that in my EMT-B course either. I'm in New York City.

~ L

 

[Icenine]

In Indiana we are still allowed to use any non-visualized airways (Combi-Tube, King, LMA, etc.). I know the the commission is considering using the national standard for basics, however to the best of my knowledge it is just a consideration. All of my services basic trucks carry them. I also have an Illinois license, and they are not allowed in that state at all for basics.

Not sure which system in IL, but my AOR (Mclean County) allows Combitube for B-P. And ET Tubes for I-P.

I think its a required secondary device for I's and suggested for P's for multiple attempts.

 

[CodyHolt83]

Allowed for use by EMT-B in Texas. Pretty cool, I think. Loved playing with them in school. lol