When to intubate

[usalsfyre]

I would bet >90% of patients sustain some sort of airway trauma from prehospital intubation. Does that mean they're all significant? No.

That said, I'd also be willing to bet if we looked at the rate of significant injury from paramedic, and even ED intubation we'd find it unacceptable. I've seen some hack jobs with a laryngoscope.

 

[Handsome Robb]

...[/B]i would much rather intubate a patient before their airway swells than have to do a surgical crich or needle crich to keep a patient alive, that is one skill we do not use enough and i would not feel very comfortable doing it in any situation

I'm going to assume that you have training beyond EMT-B since your talking about your comfort level with cricothyrotomy, either needle or surgical.

This is my opinion and am more than willing to listen to your input/critism/downright 'your a dumbass' comments.

I have never done a crich on a live patient. I've done a few on cadavers, lots on sheep tracheas and a few on high-fidelity manikins but that's about it, but I have tubed a live patient. Personally I feel that a cricothyrotomy is easier than an endotracheal intubation in equivalent patients from an airway standpoint. That's not including patients with extreme obesity and/or disfiguration, although a cadaver I cric'd was extremely obese (read 200+ kg) and after following my instructors advice to keep on cutting through the fatty tissue, the cric was easier to place than the ETT. I agree we don't use crichs very often but personally I would feel more comfortable doing a crich after a year without training or performing over doing an ETT after the same amount of time.