the 100% directionless thread

[Chimpie]

Anyone getting strange error messages in the forum? Like having to wait XX number of seconds before posting?

 

[Old Tracker]

Not here.

 

[VFlutter]

This Ketamine shortage is really cramping my style.

 

[DesertMedic66]

This Ketamine shortage is really cramping my style.

We have so far been unaffected by it but it’s going to happen in the next couple of months. We are back ordered on CATs so that’s great

 

[Tigger]

Anyone getting strange error messages in the forum? Like having to wait XX number of seconds before posting?

Kept getting a server error earlier.

 

[Tigger]

This Ketamine shortage is really cramping my style.

We aren't actually short yet but since it's on the list everytime I give it I get some kind of flak for not using something else. Oh well.

Also everytime we give it, we have to email one captain to say we gave it so he can keep track for our waiver. When you don't email him, you get yelled at, which he finds via generating a report on ESO of Ketamine use. Which begs the question, why do we even email him then?

 

[StCEMT]

This Ketamine shortage is really cramping my style.

At least you have it lol.

 

[Carlos Danger]

This Ketamine shortage is really cramping my style.

We have 500mg vials that we often give only 25mg or 50mg out of, and throw away the rest. We toss out thousands of mg's of ketamine some days.

 

[VFlutter]

At least you have it lol.

We are actually complete out. Used the last vial on my previous shift.

We have 500mg vials that we often give only 25mg or 50mg out of, and throw away the rest. We toss out thousands of mg's of ketamine some days.

Same here. It is very frustrating. Almost makes you second guess using it for analgesia. I was only using it for RSI since we were running out. But the last vial went to a pediatric patient screaming as an ER Doc was butchering a chest tube. Well worth the 450mg waste.

 

[Carlos Danger]

We are actually complete out. Used the last vial on my previous shift.



Same here. It is very frustrating. Almost makes you second guess using it for analgesia. I was only using it for RSI since we were running out. But the last vial went to a pediatric patient screaming as an ER Doc was butchering a chest tube. Well worth the 450mg waste.

If you have to choose, it is much better used as an analgesic than as an induction agent, IMHO.

We have tried to get our pharmacy to start splitting the 500mg vials into 50mg syringes. They keep telling us “don’t worry about it, we have plenty”.

 

[StCEMT]

@VFlutter have in the loose sense of the word. It's not even an option for me. I've brought it up, but all I know is it is being discussed among regional OMD's. We have some stupid regional drug box system that makes me miss Missouri.

 

[Jim37F]

Yesterday was an...interesting day..

Was getting lunch at the Costco food court, when the cute girl who was sitting at the table next to started up a conversation that ended with her giving me her number.

Then a little later, while doing the Uber Eats side gig, just as I was about to walk into a restaurant for a pickup, another girl stops me outside the front door, asking me to call 911 for her! Said she just got assaulted and sure enough, there was a big bloody goose egg on her forehead.

(And that's how I learned PD here isn't necessarily the PSAP, called, the operator answered "911" pretty much right away, explained what I got, they transferred me to police dispatch where it rang for what felt like forever lol before they picked up (it was prob only a min or two tho). Didnt really need to do much else, she was A&Ox3, denied any KO, only complained of a headache...and the cops did show up fairly quick (they rolled up non emergent...beating the engine company in district responding code 3 lol)..and that was about it.
So yeah, all in all, fairly interesting day.

 

[VentMonkey]

I finally got around to trying Bonjo’s Bougie styletted ETT technique after a couple of SNAFU’s with the Kiwi/ D-grip method.

I think I may be employing this method full time from now on.

Also, finally saw the Avengers movie. Not a huge superhero movie guy, but do enjoy the “Guardians” movies, so I obliged; pleasantly surprised.

Also, also...vacation time.

 

[Tigger]

I finally got around to trying Bonjo’s Bougie styletted ETT technique after a couple of SNAFU’s with the Kiwi/ D-grip method.

I think I may be employing this method full time from now on.

Also, finally saw the Avengers movie. Not a huge superhero movie guy, but do enjoy the “Guardians” movies, so I obliged; pleasantly surprised.

Also, also...vacation time.

What sort of issues? I had some initially with the exchange but came up with a one handed method to alleviate that.

The other issue I feel is the loss of length when preloading the bougie. If you have a crap view and are going to utilize carina holdup as an indicator, none of these methods seem to facilitate that.

 

[StCEMT]

I finally got around to trying Bonjo’s Bougie styletted ETT technique after a couple of SNAFU’s with the Kiwi/ D-grip method.

I think I may be employing this method full time from now on.

Also, finally saw the Avengers movie. Not a huge superhero movie guy, but do enjoy the “Guardians” movies, so I obliged; pleasantly surprised.

Also, also...vacation time.

I have used it all this year and it has worked really well for me. I am by no means well versed in every option that exist yet, but I am a fan of this one. With the exception of my last attempt, each one has gone very well with this set up.

 

[VentMonkey]

What sort of issues?

Having to revert back to a stylet for its advantageous rigidity. The styletted bougie seems to provide this a bit better.

I also like the ability to rotate the coude tip much easier at the top given its “Z fold”. I’m by no means exclusively buying into and blindly expecting 100% accuracy with either technique. @StCEMT I’m right there with you.

It really boils down to the “failing to prepare” mantra.

Having recently shown a class full of EMT, and ground paramedics basic to advanced tips I have learned along the way it showed me—yet again—that these [paramedic] folks have no reason to provide advanced airway management, and need to solely focus on the basics to a tee. From HFNC, to vital capacity breaths, the two-thumbs BVM etc.

I cannot enforce what the collective refuses to take seriously. Again, it’s no wonder I personally have zero desire to educate the masses.

I’m unfamiliar with the “carina holdup”. What exactly is this?

 

[DesertMedic66]

Having to revert back to a stylet for its advantageous rigidity. The styletted bougie seems to provide this a bit better.

I also like the ability to rotate the coude tip much easier at the top given its “Z fold”. I’m by no means exclusively buying into and blindly expecting 100% accuracy with either technique. @StCEMT I’m right there with you.

It really boils down to the “failing to prepare” mantra.

Having recently shown a class full of EMT, and ground paramedics basic to advanced tips I have learned along the way it showed me—yet again—that these [paramedic] folks have no reason to provide advanced airway management, and need to solely focus on the basics to a tee. From HFNC, to vital capacity breaths, the two-thumbs BVM etc.

I cannot enforce what the collective refuses to take seriously. Again, it’s no wonder I personally have zero desire to educate the masses.

I’m unfamiliar with the “carina holdup”. What exactly is this?

If you have the bougie in the trachea as you slide it down it will stop at the carina but if you are in the esophagus the bougie will no stop.... or that’s the thought process behind it.

 

[Carlos Danger]

The other issue I feel is the loss of length when preloading the bougie. If you have a crap view and are going to utilize carina holdup as an indicator, none of these methods seem to facilitate that.

Exactly. This is one of the reasons why I'm not a fan of any pre-loaded bougie techniques. The hold-up at the carina when you have a lousy view and aren't completely sure you are in the trachea is 90% of the reason to use a bougie in the first place.

That, and the unnecessary added steps and complexity of assembling the two pieces into a unit.

 

[VFlutter]

I practice the Kiwi technique in the event I need to intubate in-flight and my partner is busy doing other necessary interventions. In most other scenarios I will have plenty of hands to load the ETT on the bougie if needed.

 

[Tigger]

I practice the Kiwi technique in the event I need to intubate in-flight and my partner is busy doing other necessary interventions. In most other scenarios I will have plenty of hands to load the ETT on the bougie if needed.

I have Kiwi setup in such a way that I can pass the tube and "unhook" the bougie all with my right hand while maintaining visualization with the left. I like this for instances when the arytenoids easily discernible but your view sucks/super anterior airway. If you're above those you're in the right spot and you ran watch the tube advance to that location. I don't like losing visualization to exchange the tube and I rarely have the hands needed to competently help with that. I had one blind exchange result in a belly tube which while it was immediately apparent, it was also avoidable in the first place.

But if it's a complete disaster of an airway and your landmarks are not as clear as you'd like, you can't beat the feeling of getting holdup with bougie.