Etomindate

[CTXMEDIC]

Did you know that there are over 300 different airways that these doctors may have to come in contact with even in a short career? The devices you mentioned are just a couple from a long list of "tools" that they will see for managing an airway. Just the number of different ETTs is staggering if one was to try and list all of them.

Visualizing the cords may be just one part of the battle. You may be able to see very anterior cords but have difficulty positioning the tube directly due to other structures.

Hopefully you will see difficult airway management in a controlled setting so that you can learn some of these things before you get laughed at or your patient becomes part of the trach and peg club due to cord and throat trauma from repeated intubation attempts to save your "never miss" record.

sorry vent guy. my first difficult airway was a steeringwheel to the neck. but thanks for your words of support.

[VentMedic]

sorry vent guy. my first difficult airway was a steeringwheel to the neck. but thanks for your words of support.

No worries. This is an anonymous forum so you can brag to your heart's content. Whatever knowlege you possess will become evident in your other posts.

[Doczilla]

It has always been my understanding that the Glidescope is a RESCUE tool, where DL should be used primarily. If you can't get it with DL, move to a different tool. Of course, not all the residents at the hospital I work at follow this thought process. Hope they don't go to a hospital that doesn't have any of the fancy stuff... :?

It can be a rescue tool, but I use it frequently as a primary method of intubation on many patients, particularly ones that meet a certain profile as a difficult airway where I think that the GL will intubate them safely. Our anesthesiologists use it often on elective intubations on the floor as well. Like everything else, it's another tool in the tool bag, one that needs to be applied properly. If it is only used to bail you out of a bad airway and failed intubation, you won't be very good at using it.

'zilla

[p3medic]

We had the Glidescope on the trucks for a while for a trial, really liked it. You could get a grade 1 view on patients that with DL you might get a 3. It had limitations, secretions and blood tended to muck up the view, despite the heated lens and passing the tube was different due to the angle difference. With the Glidescope you don't displace the anatomy like you do with DL, its "glided" along the natural curvature of the airway. As of yet we haven't purchased them, hopefully we will. There are patients out there that the GS could make a huge difference with. I had a patient a few weeks back that was 1 week post op from a cervical spinal fusion, had no neck mobility, a recessed jaw, malampatti 4 airway, and a grade 4 view on DL. I'm quite certain that the glidescope would have performed wonderfully for this patient.

[CTXMEDIC]

No worries. This is an anonymous forum so you can brag to your heart's content. Whatever knowlege you possess will become evident in your other posts.

You sound as if you speak from experience. as for me, ive just been lucky. as i previously stated, im sure my time will come. you'll be the first guy i address if and when i tube someones gut. i promise.

[VentMedic]

You sound as if you speak from experience. as for me, ive just been lucky. as i previously stated, im sure my time will come. you'll be the first guy i address if and when i tube someones gut. i promise.

I do have a lot of experience when it comes to airways. I hope you would first take the time to correct your tube placement before running to the computer to inform me. At sometime during one's career almost everyone may put a tube into the esophagus. It is when they don't realize it that it becomes a problem.

I personally could care less how good you are intubating so you can save the arrogant remarks. I just disagree with your blatant criticism of students and/or professionals learning new things when you yourself have expressed limited knowledge for establishing a secure airway by any means other than DL.

[Miss Sasha]

You sound as if you speak from experience. as for me, ive just been lucky. as i previously stated, im sure my time will come. you'll be the first guy i address if and when i tube someones gut. i promise.

In my very limited experience, the ones who brag they never miss don't do it enough to allow the opprotunity to miss.

[Laura Anne]

Wow...LOL... I was enjoying this thread until it started to get a bit side tracked.... or at least my mind did..... :shock:

"Oh yeah!?! Well MINE never misses!!!"

" OOOHH YEAAH!??!!? Well mine is a MAC 4!!"

"EW!!! YOU like YOURS curved?!!?! I have a MILLER 3!!!"

" Well, la-dee-da!!! I have a one like a bouchie......oh wait.....hmmmm.... :oops: "

8)

Anyhoo..... We carry Etomidate, Valium, Versed, and Fentynal at my full time job. I have used Etomidate only once and the co-worker medic I was with pushed it a Slow IVP. Needless to say it didn't really work like I would have liked it to. If anything, it caused more problems!! I edned up calling medical command and getting orders now for 100mcg Fentynal and Versed 5mg with 2mg post intubation for sedation and it did the job.

[chbare]

What sort of problems? Or, are we going back to a prior point? It sounds like a paralytic was not utilized, and this is another case of the ever so popular PAI? If that is the case, I am not surprised problems were encountered.

Take care,

chbare.

[p3medic]

Some of the problems associated with etomidate, i.e. masseter spasm, myoclonus are aleviated by following it with a paralytic. Etomidate by itself can be problematic.