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Here's another study that I found interesting. http://www.ncbi.nlm.nih.gov/pubmed/22465807 What with all the sturm und drang (read: hoopla) about ET tubes and such, it seems that in porcine models in V-fib arrest with CPR in progress, placing a supraglottic airway significantly decreases the amount of carotid blood flow. That is, I think, really bad. Do you think this will have any ramifications on EMS practice? I doubt it. After all we found out back in 1978 that buccal glucose doesn't work but that didn't stop anybody.

I wanted to post an interesting airway scenario, not to elicit right or wrong answers but to allow people the opportunity to discuss their approach (with reasoning) to this specific airway. Scene – 32 y/o male with a self inflicted knife wound to anterior neck (suicide attempt). The patient was awake with an 8 cm laceration through his Thyroid Cartilage above his Cricoid Cartilage that had transected his trachea, leaving approximately 2 cm portion of his tracheal ring in place. EMS had started an IV of crystalloid, placed a NRB over patients opening in neck (think of a trach mask – similar thought) and administered 4 mg of Zofran IV. Upon our assessment we found patient sitting upright, awake, non-verbal, vitals HR 110 sinus, BP 136/70, RR 14 SpO2 92%. Anterior neck presents as listed, with edema and oozing from around laceration site, the patient’s NRB was blood specked. Questions to be answered:(1) Do you consider this patient airway stable (flight time to tertiary care is 17 min, ground time to local hospital is 20 min) (2) Do you feel as though you can maintain his present airway (3) If you feel that you need to intervene with this patients airway, why and what approach would you take – at your disposal are the following adjuncts: normal ETT kit, bougie, LMA, surgical cric kit Medications available: Fentanyl, Midazolam, Lorazepam, Morphine, Succinyhcholine, Vecuronium, Pavulon, Etomidate, you are also in an ALS ambulance with normal supplies (4) Are you concerned with the fact that he is a suicide attempt I look forward to posts, I will respond with our approach to this airway after people have given some thought and discussion. Sean