The Disappearing Endotracheal Tube

[paramedicmike]

Skills such as Mallampati scoring should be standard.

Really? Because you always get to assess your patient's while they're sitting up and able to get into the sniffing position?

Otherwise, you make some good points.

The problem we're facing, once again, is education. Fix the educational shortcomings and I think we'll see immediate changes in the practice of prehospital medicine.

-be safe

[MontvilleFire39]

Really? Because you always get to assess your patient's while they're sitting up and able to get into the sniffing position?

Otherwise, you make some good points.

The problem we're facing, once again, is education. Fix the educational shortcomings and I think we'll see immediate changes in the practice of prehospital medicine.

-be safe

Ya, really. While not able to be done in all situations it s plausible . Elelevate strethcer to 90 degrees, place patient into sniffing position. That was just one example. Thyromental distance and Mentum-Hyoid distance canbe assesed and provide some insight into the difficulty or ease of an intubation.

Like you said, much of the ETT failire rate is due to educational shortcomings. On top of entry level education, may providers fail to coninually educate themselves as well. Their is a wealth of continuing ed opportunities out there; classroom sessions, structured on line con ed, online information, intentional educational dialog and debate with other providers etc....While no one method is best a combination of all is essential for maintaining competence and staying abreast of changes in practice.

[2wheelinemt]

[iam sorry but I had to jump here on th one comment that was made about who would you rather have put a tube in?

Well I was in he hosp for the past two weeks and the so called peope standing around that hae just ONE job to do intead of 5 different skills, well they messed up big time. I was getting a line in the neck and they totally blew it and sent a bleed into my neck and what the docs no thought to be a bleed into my chest. So whom is ready for what want to know?

[MontvilleFire39]

[iam sorry but I had to jump here on th one comment that was made about who would you rather have put a tube in?

Well I was in he hosp for the past two weeks and the so called peope standing around that hae just ONE job to do intead of 5 different skills, well they messed up big time. I was getting a line in the neck and they totally blew it and sent a bleed into my neck and what the docs no thought to be a bleed into my chest. So whom is ready for what want to know?

WTF are you talking about? I was unaware you could send a bleed....gimee your address and I'll send you one in the mail...Priority Mail flat rate $4.99...who wants one?

You sound like so many of the patients I pick up who refuse to go to a certain hospital because they "killed" mama...

Sorry to be harsh but try to post in a more inteligible form to invoke a more warm, fuzzy response.

[Dustdevil]

LOL! This thread suddenly has epic potential!

[chbare]

[iam sorry but I had to jump here on th one comment that was made about who would you rather have put a tube in?

Well I was in he hosp for the past two weeks and the so called peope standing around that hae just ONE job to do intead of 5 different skills, well they messed up big time. I was getting a line in the neck and they totally blew it and sent a bleed into my neck and what the docs no thought to be a bleed into my chest. So whom is ready for what want to know?

Wow. Well, if I understand you correctly, you are using your providers error as an excuse to justify our problems as EMS providers? So what? Your provider blew an EJ or subclavian. While that is potentially bad for you, it has nothing to do with the current topic. In addition, did you take the time to read my comment about pointing to the bad behavior of other professions?

Take care,

chbare.

[grems4305]

You heard it here FIRST - the real answer is cryogenics - no more prehospital care - show up and freeze the patient - stops all cellular degrigation and tissue damage - once at the hospital (no hurry getting there - stop at circle K for a thirstbuster) they can run the scans and test, plan the treatment, collect the fee then un-freeze them.

Think about how this will deter the frequent flyers.

[RatPack]

WTF are you talking about? I was unaware you could send a bleed....gimee your address and I'll send you one in the mail...Priority Mail flat rate $4.99...who wants one?

You sound like so many of the patients I pick up who refuse to go to a certain hospital because they "killed" mama...

Sorry to be harsh but try to post in a more inteligible form to invoke a more warm, fuzzy response.

Ya what he said

[Spock]

I would suggest that everyone read the Bledsoe/Gandy article closely. The article is well written and is the best review of the literature in one place that I have seen in a long time. The most important point they make is that managing an airway is about ventilating the patient and not just putting the tube in the right hole. As I have said before you can teach a monkey to intubate but not when to intubate. That is the difference between training and education.

Most of the medics I know cry that ETI may be taken away from them but they aren't willing to take the steps necessary to maintain their skills. I couldn't agree more with ventmedic's comment on intubating the manequin. It requires you to go through the steps of ETI in an orderly fashion so that when you have to intubate a patient it is second nature. Checklists are one of the reasons the airline industry has such a good safety record. After that plane crashed in the Hudson River the pilot left the cockpit to see that the passengers were evacuating while the copilot stayed in his seat and went through the evacuation checklist. That is professionalism and bravery all at once!

I don't know where ETI is heading in the future for EMS but at the least we must think about restricting the skill to only those that will do it often enough to maintain proficiency. That means at least 15-20 tubes per year. Very few medics will be able to attain those numbers.

On a personal note I will say that I will never be burned by an esophageal intubation by a medic again. The next time they bring a tubed patient into the trauma bay without wave form capnography to verify tube placement I will get my scope and look for myself. No more giving the medic the benefit of the doubt. I will also rip him an new hole for not using capnography and putting the tube in the goose. If you are doing a procedure you must do it correctly or not at all.

Live long and prosper.

Spock

[scott33]

The next time they bring a tubed patient into the trauma bay without wave form capnography to verify tube placement I will get my scope and look for myself.

This has been mandated as the standard of care in my part of the world since January. You can't tube if you don't have the ability to provide a waveform.

I still think it will only go a small way to delay the inevitable - the loss of ETI for medics (other than the critical care / flight teams)