What do you think?

[snaketooth10k]

Just no. Basics have the tools to keep a patient alive long enough for ALS to arrive and intubate. The risk just far outweigh the benefit. Especially when the risks include death, and the paramedics are, in most cases, a mere call away.

Maybe where you live, but our squad has seen medic delays of over 30 minutes while carrying critical patients. I just read a long instructional article on use of the combitube, and it seems like a viable option if using a standard ET tube is too risky for a B. The LMA also seems like a good tool for basics. I do think that the patients must be in cardiac and respiratory arrest as well as unresponsive though.

 

[Hastings]

Maybe where you live, but our squad has seen medic delays of over 30 minutes while carrying critical patients. I just read a long instructional article on use of the combitube, and it seems like a viable option if using a standard ET tube is too risky for a B. The LMA also seems like a good tool for basics. I do think that the patients must be in cardiac and respiratory arrest as well as unresponsive though.

Yes. The combitube is a great alternative for a basic. It's easy to put in, it secures the airway, and even medics resort to it if they can't get an ET.

 

[triemal04]

I'm gonna disagree with you here. One of my Instructors intubated 4 times as a basic and got 3 of them back...

So your instructor tubed 4 people who were pulseless and apneic, then performed BLS care only, and got a heartbeat back on 3 of them? Hmmm....

 

[Hastings]

So your instructor tubed 4 people who were pulseless and apneic, then performed BLS care only, and got a heartbeat back on 3 of them? Hmmm....

Earth-shattering CPR and a Magic AED.

 

[Jon]

Yes. The combitube is a great alternative for a basic. It's easy to put in, it secures the airway, and even medics resort to it if they can't get an ET.

Combitube... that's so 2 years ago.

King LTD all the way!

 

[So. IL Medic]

Vent, a question. A Basic asked me this and I didn't have a good answer other than an ET tube is a more definative airway.

We had a code, an obese pt with a very anterior trach. I couldn't get the tube on the first pass. Didn't try for a second, instead grabbed a King and inserted it while he was doing compressions. Good lung sounds bilat. Off we went. On arrival at the ER, the doc pulled the King. Tried four times to get the tube unsuccessfully. The question my partner asked was why remove a good, workable airway in the middle of a code? I've seen it happen a few times too.

 

[Hastings]

Combitube... that's so 2 years ago.

King LTD all the way!

Actually, heard our service recently switched to those due to the price of the Combitube, but I haven't been trained on it yet since medics do tend to rely on the ET instead. I should get on that.

 

[el Murpharino]

Actually, heard our service recently switched to those due to the price of the Combitube, but I haven't been trained on it yet since medics do tend to rely on the ET instead. I should get on that.

I'm pretty sure you can be trained on the King in about....oh...10 minutes. That may even be stretching it.

 

[Ridryder911]

Vent, a question. A Basic asked me this and I didn't have a good answer other than an ET tube is a more definative airway.

We had a code, an obese pt with a very anterior trach. I couldn't get the tube on the first pass. Didn't try for a second, instead grabbed a King and inserted it while he was doing compressions. Good lung sounds bilat. Off we went. On arrival at the ER, the doc pulled the King. Tried four times to get the tube unsuccessfully. The question my partner asked was why remove a good, workable airway in the middle of a code? I've seen it happen a few times too.

I am not Vent, but I will give you my opinion. As a Paramedic you should had recognize that all other airways are alternative airway. Only the ETT is a definitive airway. As well, I am sure he might not have known what the "king" airway was. I do not criticize for pulling the airway, but if he did not re-insert then there is a problem.

Remember as well, the alternative airways are only temporary too.

I ask if anyone is using the flexguide or bougie elastic guide? I now use it for anterior intubations, and have not had a problem. One of larger metro services has been using them for about fiver years now & their success went from 92% to 98% rate (>40 intubations per week). They are cheap, easy to use and disposable.

R/r 911

 

[Flight-LP]

We've used them for a couple of years now, great adjunct to assist with intubation.

 

[el Murpharino]

The bougie is a great tool to assist with tough intubations; we've been using them for a year or two now. I was introduced to them when I took a difficult airway management course.

 

[VentMedic]

I am not Vent, but I will give you my opinion. As a Paramedic you should had recognize that all other airways are alternative airway. Only the ETT is a definitive airway. As well, I am sure he might not have known what the "king" airway was. I do not criticize for pulling the airway, but if he did not re-insert then there is a problem.

Remember as well, the alternative airways are only temporary too.

I ask if anyone is using the flexguide or bougie elastic guide? I now use it for anterior intubations, and have not had a problem. One of larger metro services has been using them for about fiver years now & their success went from 92% to 98% rate (>40 intubations per week). They are cheap, easy to use and disposable.

R/r 911

Inside the hospital, codes are critiqued heavily. Airway will be the first thing to be scrutinized and what steps were taken to secure a definitive airway. If the pt had ROSC, only an Endotracheal Tube is approved to be on a ventilator. A hospital should have a difficult airway cart and some highly trained medical professionals capable of getting a definitive airway. If not, another alternative airway could have been reinserted until the equipment and personnel arrived if the BVM was ineffective.

Agree, the bougie is an excellent device.

I have gotten a lot of intubation opportunities in the ED because of Combitubes and some ALS crews who don't bother keeping their intubation skills adequate or just lazy. Changing out the Combitube is not my favorite thing to do because there is always the chance for esophageal or larynx/trachea damage that will later result in a legal process if there are complications that must be dealt with. There will also be the lengthy medical recovery from those complications along with whatever caused them to be intubated that may be challenging for the patient if they live and the medical staff.

We also change out some field ETTs that are not the appropriate size, are dirty (not just blood and vomit) or there is a possibility the patient will have several vent days. We have tubes designed to decrease the risk of ventilator associated PNA.

 

[Jon]

Vent - What's your take on King LTD vs. Combitube?

 

[VentMedic]

Vent - What's your take on King LTD vs. Combitube?

In all honesty, I have not put either of these tubes in a patient during an emergency. I have only removed them to intubate with an ETT. I have practiced using them on manikins and cadavers. The King seems to be easier. The Combitube is large and can damage the cords if it does pass through them blindly. Of course, if the patient is coding, the concern for damaging the cords may not be a thought. It may, however, present problems when a definitive airway is attempted and/or if the patient survives. That problem I have encountered when changing tubes.
I do like that you can suction the stomach easier with the Combitube.

If I didn't have my other devices to facilitate intubation, I would probably go with the King. It reminds me of the old EOA, which all the BLS trucks in my area used to carry in the 70s and 80s, only better.

 

[PNWMedic]

Well I think that might be reserved for remote EMTs (EMT's responding to a call where it may take a while to arrive at definitive care). In my Wilderness EMT course we were trained in ET Tube Intubation, although I have never used it. So i'm not sure, could be a cert on top of the regular EMT-B?

 

[So. IL Medic]

Thank you, Vent. I had not been thinking along the lines of post-resuscitation, instead focused on the immediate working the code. My thoughts are an airway with good ventilations is better than attempting the definitive airway during the code. Could the ETT wait until resuscitation is determined or would that be a negative in the code critique?