the 100% directionless thread

StCEMT

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So I am gonna try to help set up an airway review for our field providers. Things I am going to include are apneic oxygenation, SALAD method, two curve theory and anatomy, methods for positioning, aspiration and ventilator associated pneumonia, trouble shooting VL, and a few other bits as I think of them.

Do y'all have any suggestions for other things to include? I've got tons of stuff saved to my computer, but there may very well be things I'm not thinking of that are worth adding. If there are any studies you have for them as well, PM me or share here.
 

Tigger

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So I am gonna try to help set up an airway review for our field providers. Things I am going to include are apneic oxygenation, SALAD method, two curve theory and anatomy, methods for positioning, aspiration and ventilator associated pneumonia, trouble shooting VL, and a few other bits as I think of them.

Do y'all have any suggestions for other things to include? I've got tons of stuff saved to my computer, but there may very well be things I'm not thinking of that are worth adding. If there are any studies you have for them as well, PM me or share here.
Maybe review improved BVM technique? Not sure what you do now, but sometimes when we show people the value of two people and the thenar eminence techniques it can be quite eye opening.
 

Qulevrius

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So I am gonna try to help set up an airway review for our field providers. Things I am going to include are apneic oxygenation, SALAD method, two curve theory and anatomy, methods for positioning, aspiration and ventilator associated pneumonia, trouble shooting VL, and a few other bits as I think of them.

Do y'all have any suggestions for other things to include? I've got tons of stuff saved to my computer, but there may very well be things I'm not thinking of that are worth adding. If there are any studies you have for them as well, PM me or share here.
Suction review maybe. Seems easy, but lots of people muck it up. Both Yankaers and French catch, plus (maybe) deep trach suctioning, if it’s in the protocols.
 

PotatoMedic

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Had fun working in a fly car as a medic the other day.

Also put in an application for the local flight company!
 

Tigger

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Had fun working in a fly car as a medic the other day.

Also put in an application for the local flight company!
I would love dearly to work a fly car system. Sadly it's not really a model that exists in Colorado right now.
 

Virgil

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We get I think 6 weeks. Califorinia EDD pays 4 weeks @ 80% gross with no waiting period. Might be 6 weeks, but I'm not sure, I only took 30 days because if it's longer you have to take the PAT again.
Oh, thats great. I just started at my division, but I don't think I can get it since I haven't been there for a year. If EDD can pay me for at least 30 days, then I'm fine with that. I guess I should just take a Personal leave of absence if AMR won't give me the FMLA.
 

PotatoMedic

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I would love dearly to work a fly car system. Sadly it's not really a model that exists in Colorado right now.
We rarely have a fly car. It only happens when we have extra staffing and can't make an extra car. They also only let providers who have been out in the field over a year work a fly car. Honestly most people just work as a third, but I think I am going to try to be a fly as often as I can. Loved it!
 

9D4

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My mother has a story she loves recounting; got asked what I wanted to be when I was older when I was about 8. I responded with "well, a college student".
The person (can't remember who it was) said "what about after?"
I apparently acted like it was the day I found out Santa wasn't real and was upset that I found out that I couldn't just go to school for the rest of my life 😂
So yes; very, very much a nerd 😬
 

CANMAN

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Maybe review improved BVM technique? Not sure what you do now, but sometimes when we show people the value of two people and the thenar eminence techniques it can be quite eye opening.
👏👏👏 Can't agree enough on this.... Also, far too often we give the task of BVM ventilations to some of the least trained or experienced providers on scene during those scenarios when in reality I want to be the person in charge of that situation if I am about to management an airway or they're not doing a great job at it.

I have never been a big fan of the C-E technique for single person BVM ventilations, and actually use like a modified thenar eminence technique for single provider management as well. When I used to go to the O.R. at my old flight program for quarter tubes it would always draw weird looks and concern with some of the anesthesia providers but I was comfortably able to mask any size patient for a prolong period without the fatigue that you get from C-E, and without a leak. Most masks have a notch on them, I rest my hand there, encircling the connector portion where BVM meets mask between my thumb and pointer finger, then use pointer through pinkie finger to lift the mandible into the mask vs. trying to press the mask down. You would be amazed at how using all four fingers in one vector increased your ability to maintain a mask seal and decreases hand fatigue.
 

DesertMedic66

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Well this is fun. 6.4 earthquake hit. In the process of a partial hospital evacuation. Multiple ambulance strike teams, close to 10 HEMS units, with others staging close by.
 

CANMAN

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Great article and touches on what I was talking about. I definitely support the modified two handed as shown in those pictures for two person BVM. Doesn't touch on what I described for single provider BVM in there and it's hard to describe I guess. I should take a picture and report back. I am one of very few people I have seen that mask someone that way, but it's much easier and effective. I get alot of questions from residents and attendings in our trauma bays about the technique when it's our airway day. I also teach it at the difficult airway lab for our area and maybe people, especially those with smaller hands find it effective. Will try to grab a pic on my next shift.
 

9D4

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Great article and touches on what I was talking about. I definitely support the modified two handed as shown in those pictures for two person BVM. Doesn't touch on what I described for single provider BVM in there and it's hard to describe I guess. I should take a picture and report back. I am one of very few people I have seen that mask someone that way, but it's much easier and effective. I get alot of questions from residents and attendings in our trauma bays about the technique when it's our airway day. I also teach it at the difficult airway lab for our area and maybe people, especially those with smaller hands find it effective. Will try to grab a pic on my next shift.
A gent I used to work with would do a modified 2 handed seal even when he was the only person bagging.
He'd basically look like he was duck winging it and held the seal with both hands, squeezing the bag with his elbow between his abdomen. Was always super interesting to watch. I managed to try it once, but I felt like I needed a lab environment to get it down pat, so ultimately I never utilized it. Not gonna lie, it did feel like a better seal.
It always appeared that he was super conscientious of his bag rate and his tidal volume seemed adequate.
 

Tigger

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We rarely have a fly car. It only happens when we have extra staffing and can't make an extra car. They also only let providers who have been out in the field over a year work a fly car. Honestly most people just work as a third, but I think I am going to try to be a fly as often as I can. Loved it!
My old service staffed five everyday, the third person took an ambulance by themself to a call. We had a flycar but you were supposed to take the ambulance, find a driver on scene, and handle the call. Fortunately some tax increases have remedied that but man, I never felt more alone than driving a big truck alone to the scene hoping that a half decent volunteer might show up.
 

PotatoMedic

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TransportJockey

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Ugh I think I screwed up my back a couple shifts ago lifting someone heavy on an emergent patient. It’s slowly gotten worse so now I have to see what I can do.
 
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