The second is your alive but dying patient. Pill overdoses with unresponsive patients you've got a good chance of vomiting. It's not easy to manage a large patient in the back of an ambulance that is vomiting all over, aspirating and compounding their already significant problems. It is easy to manage a properly timed and performed ETT. Not in the sense that you've nothing left to do but in the interest of the patient there are times where taking absolute control of that patients airway is very nessasary. I do not work in a system that allows RSI and I have only once come across a patient that had me wishing I could. He was immediately RSId in the ER. And again no, just because a doc will do it anyways is not the reasoning.
I'm not of the crowd that is saying I want to intubate more people!!!
If I contnue to come across as a badass motherfuckin new paramedic swingin my **** around that is not me. I am new to this game but I'm not running in to calls laryngoscope in hand like **** yes my patient is dying. I posted before regarding narcan use routinely. I'm not for a big blanket, black and white practice but medicine. I don't have study's I can pull out of my *** at the moment I can only speak from my limited experience. And as I said before all of us could benefit from more foundational knowledge and experience.
Yeah, I have to agree with Chase, no one called you young, or dumb; inexperienced, perhaps? But it seems like you've taken it the wrong way. If anything, maybe you should be flattered the guy is trying to enlighten you. He's a well educated, and experienced nurse with significant ICU time.
Something also worth mentioning is that this thread was created and shown to question the importance of early
in-hospital intubation. If it's postulating it's ineffectiveness in early in-hospital arrests in a much more controlled, and presumably sterile environment with a vast array of experienced airway experts why should we be allowed the same privileges without any profound documentation, EBM, literature, etc. other than it being the "gold standard"?
Again, I can respect your opinion, and know I too was once there, but I chose to take it upon myself to become better acquainted with airway management, not just the intubation; I seem to be echoing this a lot. I had a instructor who was adamant about gastric tubes being placed, and that an ET tube without one is just about useless, where does this fit into your aspiration patient? If you intubate said patient should you be placing them on the ventilator immediately even with very basic settings, and parameters? Is hand-bagging with a BVM the same as the ventilator, why or why not? If you arrive to find fire or whoever has placed a SGA that is showing adequate oxygenation, and ventilation why do
WE need to pull it? What about the morbidly obese patient with a grade 4 mallampati? How would you protect their airway? are we going to need to change our choice of airway devices from the start, is a SGA sufficient in this case? What about DL vs. VL, where do they fit into one's plans for first time success? That is the goal, and not because any of us should be ego-driven, but because the patient doesn't deserve anything less. What techniques can you use to improve their likelihood of not desaturating? When you first walk in and find a patient that needs to be intubated should you have a back up airway in mind already, and if so, what would it be, and can it provide adequate oxygenation, and ventilation in the face of the unforeseen failed intubation?
I'm not asking you to answer any of these questions, nor do I care how much experience you do, or don't have. This is merely the "tip of the iceberg" that should be going through a prudent airway clinicians mind pre-intubation, at least in my opinion; they go through my mind.
