Snafu3532

Thanks for all your replies. Unfortunately we do not have RSI in my area, the best we have is sedation with a King airway which is what inspired my questioning to begin with As for the amount of time for airway management, I think the source of the "scoop and run" mentality is from a lack of understanding of continuity of care. Although surgery is the definitive care for trauma, before that can happen the patient is going to be intubated at some point -- whether that's by the anesthesiologist in the OR, by the physician at the ED or by the paramedic in the field, the 2 minutes of the "golden hour" for airway management is going to be used at some point along the way. It's a matter of where and when, and there is a benefit to sooner rather than later.

Okay I've been thinking about this more and want to rephrase my question. To be perfectly clear this question is not about airway management. There is unquestionably a lot of consideration that goes into selecting the appropriate airway for a patient and can be very specific to situation and preference. What I'm wondering is if the nerves in the oropharynx that cause ICP, or the vagus nerve and its reflexive bradycardia for that matter, would be continuously stimulated by a supraglotic airway due to the constant pressure of the pharyngeal/esophogeal balloons, or if they would become conditioned to such a stimulus and these responses would subside after the initial insertion. I know the tactile receptors of the skin do not undergo adaptation and it is thalamic filtering that causes you to not feel the clothes on your back, etc. I'm wondering if the cranial nerves undergo adaptation and the reflexive increase in ICP and bradycardia of oropharyngeal stimulation would eventually subside. I hope this helps a little bit. If someone wants to offer input on airway selection in light of any answers to this, that is just a bonus. Perhaps if the option of simple premedication with lidocaine/fentanyl is out due to constant reflex stimulation, what other avenues could one pursue?

Short and sweet: In a situation of a trauma patient with increased intracranial pressure(ICP), would a supraglotic airway (i.e. king, combitube, LMA, etc.) cause a greater increase in ICP (say, compared to laryngoscopy and ET tube placement) due to its constant pressure on pharyngeal structures? Back story (for those who are interested): In medic class we were discussing a scenario of head trauma patient (I'll leave out the details for now and add them later if they become pertinent) who seemed to be decompensating and required airway management. The area I'm in is largely advocating the use of supraglotic airways over intubation in the prehospital setting and I asked if a supraglotic airway would be problematic in this situation as the sustained pressure would might a more significant increase in ICP over the breif pressure required to use a laryngoscope and intubate. My instructors were unable to provide an answer so I figured I'd pose the question to The City. Thanks in advance for any enlightenment anyone can provide.

I've always been quite skinny and can eat just about anything without gaining weight...thanks, 20 year old metabolism. I started P90X to put on some muscle, and the "get RIPPED in 90 days" slogan was pretty appealing. I started to see some impressive results after only a month, but got too busy to keep up with it once the academic semester got into full swing. I have a friend who completed the 90 days and swears by it; however he said you really need to keep up some sort of fitness routine or the results fade fast once you're done. The workout is actually really enjoyable and I wish I had the time to keep it up...perhaps when I graduate in May I also have a few friends who are doing the Insanity 60 day thing (it's made by the same company). Insanity seems to be cardio focused whereas P90X is more about muscle building. Either way they're both pretty intense. I'd recommend them to anyone who isn't comfortable in a gym or doesn't want trek there.

You all are reading too far into this. This was OBVIOUSLY a case of Lazarus syndrome and thus the firefighters are absolved. I mean come on...everyone knows that they can do no wrong...

Okay I do not have any information about NYC life, but I do have a question for you... You are moving all the way up to New York because your daughter wants to go to school there? Are you doing this to get in-state tuition, or just so your daughter is not so far away? If the latter is the case, perhaps you should consider that part of the college experience is being away from home. Your daughter might even been interested in NYC because of the distance. This question might be a little presumptuous, but it can be huge if overlooked. I suggest talking to your daughter about it if you haven't already. Good luck!

Unfortunately, through out my lengthy scholastic career my outspoken personality has not fared well with the few sub-par instructors I have come across. The upside is I have learned how to bring up an issue with an instructor being wrong without doing too much damage to an ego. The best method is to present her incorrect information as your own confusion...therefore you aren't saying she is wrong, you are merely "having trouble grasping the concept". For this specific example, I would bring it up like this: "I'm having a little trouble keeping the terminology chronotropy and inotropy straight. For instance, the "chrono" prefix usually relates to time. Like chronoic means occuring over a long time, and Chronos was the Greek god of time (you can come up with your own equally nerdy examples). Yet here that doesn't seem to be the case. Is there a reason for this?" This will hopefully get your instructor to question the truth of their own knowledge and they will look into it. If this doesn't work, you could go down the road of bringing in some sources. Hope this help.

I also questioned the protests in Iraq about the shoe-throwers prosecution. If you go by the assumption that this was a malicious attempt to harm then it is plain and simple assault and should be prosecuted as such. If you are going under the assumption that this was a "peaceful" protest the man should still be prosecuted. The point of a protest is to say that you feel so strongly about something that you are willing to act outside the rules of society, even if it means paying whatever penalty the law dictates...whether its anything from paying a fine to execution. You cannot allow individuals to express their opinion in disorderly ways, no matter how justified you think it is...otherwise you would have people from this forum throwing shoes about education/firefighters/nurses/protocols/losing at monopoly/etc. We discussed this very issue in my Philosophy class in conjunction with Martin Luther King Jr.'s "Letter from Birmingham Jail". I might add more later.

I definitely saw a thread on this a while ago but can't remember what arguments were made...if my memory serves me correctly there were no legitimate ones in favor of it. Reporting blood pressures in even numbers only???

Now all they need to do is pick up sickle cell anemia as their charity - to be more inclusive and all..... :roll:

I think many people mistakenly use the term "stable" for "within normal limits". If a patient has a constant heart rate of zero and it never changes, is this "stable"?

hahaha well said mrmeaner. what are you implying spenac?

Where I am we sign in with the hospital whenever we respond somewhere. We get dispatched to a car that drove into a house. Ambulance: responding to a house vs car. Hospital: recieved, are you saying it was the house that was mobile? Ambulance (after realizing they reversed to two): uhhh...that is unknown at this time, we will advise. I guess it could have been a motor home...

Okay, I was unable to watch the video, but I have many thoughts on the subject just based on the title. First off, I guess I need to embrace a shameful past and admit that I came from a program that I imagine is much like this one. Students in my high school could get trained as EMT's at 16 y/o and each day 4 would be on duty, wear pagers, and respond from class in a chase car. While I appreciate the experience it gave me, the program is deleterious for many reasons. To begin with, the maturity and education level of high school students is substandard. I worked with a few very bright, motivated, and mature peers; however the screening process to weed out those who are not is inadequate if existent at all. (now that I think about it, this issue is prevalent in EMS, no matter what the age). Some people say that is the purpose of the state EMT exam, but I think this too is inadequate. To hit on CC64's point, our chase car was driven by a custodian because the insurance company would not cover 16 year olds to drive. So insurance wouldn't endorse us driving to the scene of an emergency...but the town encouraged us to provide medical care once we got there? Secondly, this program breeds whackerism. While the few bright, motivated, mature individuals in the program were genuinely interested in the intellectual medical aspect, too many just liked the title and being able to run out of class. Thirdly, the reason the program came about was because the majority of people in my town work 9-5 jobs so there was nobody to volunteer to respond to ambulance calls. So rather than institute a paid, full time ambulance staff, they opened up the volunteer position to children. Like I said previously, I am grateful for the experience I obtained while in the program. It allowed me to see what EMS has to offer and begin my education early. None the less, I think there are better ways to provide this to high school students without relying on them for primary emergency medical care. P.S. read the comments under the video, particularly the ones by jediSCUME and fabifly...these scared me quite a bit.

On top of all the excellent advice previously mentioned, I would like to add that I have found it very useful to look at aerial photos while studying from a map. This way you get a better idea of what streets/intersections/neighborhoods actually look like, as well as being able to discern landmarks and scroll through what would be multiple pages of a map. A great sight i found for this is www.flashearth.com (I apologize if the link is not coded correctly, I have never posted a link before and couldn't find any directions despite use of the search feature)