Intubations for 2009

[Jwade]

My gut tells me this poster is trolling for an argument, however,

1. I agree that one cannot reasonably expect to " Get them all" BUT, 82% is pretty poor.

2. If you have never used a backup rescue airway, how did you manage those 5 airways you could not secure?

3. My personal limitation for Intubation on the aircraft are 2 attempts at DL, followed by 1 attempt by my partner, and then we switch to King, Combitube, LMA, Crich, etc......

4. Any reasonable competent ER will not arbitrarily pull a rescue airway if it is providing oxygenation and ventilation until they have sufficient resources available. In my world, this means having an MDA or CRNA at the bedside ready to manage the airway. ER docs like to think they are the airway guru's but, when the SH$T hits the fan, who do they call? Anesthesia!

5. Having success with difficult intubations is all well and good, but the most important issue in my mind is being able to do a complete airway exam and recognize when things have the potential to get FUBAR. It is important to recognize when EGO is dictating the outcome and you as a competent provider must have the ability to say, just because I can, should I be doing this?

Respectfully,

JW

[croaker260]

Now, keep in mind that up until October I was 1/2 time in the field and 1/2 in education....so my opportunity for field tunes was below average.

I think I have had either 6 or 7 live tubes, 3 of wich I would classify as difficult (1 400 pounder respiratory --> cardiac arrest- got on 2nd attempt with a 4 miller, 1- severe facial trauma from auto-bike and unable to ventilate due to trauma- got on 1st with 3 mac and a bougie, 1 code--> simply very anterior---> C&L grade 3 view --> got on 2nd attempt with the bougie and a 4 mac)

All had an ETT by the second attempt, most on the first. Still hoping to grab one or two more this year. This is the first year I can remember not having a nasal...but this is the firt full year we have had CPAP on the rigs too.

We as a service squeak by with 6-12/year/medic .(All types of tube, RSI, Nasal, Oral, Etc) ..though I know of some black clouds that have had quite a bit more.... ..not great I know. Unfortunately ALL of the local ORs have shut their doors to everyone except Their own Air Medical..and them only grudgingly. This is unfortunately the reality. We don't have a true teaching hospital in this state, so its difficult to get true OR time....

Now to off set this, we do critical skills training twice a year with our docs (which includes difficult airway) and this year incorporated sim man difficult airway scenarios as well. All of our personnel go through this, EMT through medic, for teamwork purposes. We also do difficult airway stuff in the annual refresher course that includes pig trachs and sim man.

So while not as good as getting in the OR... we have made every effort to compensate and do take it seriously.

[flight-lp]

17 total, 16 successful oral, 1 unsuccessful with a King LT placed.

3 unassisted intubations secondary to respiratory failure / cardiac arrest.

14 by PAI / RSI.

Air Medical - 3 intubations required per quarter.

Ground CCT - No current requirement, but will soon mimic the air medical requirment.

911 - No requirement, usually a sufficient number of patients volunteer their services, lol.

[CBEMT]

1 opportunity, 1 tube placed. No requirements.

[Just Plain Ruff]

6 tubes 6 successful -

4 in field and 2 in hospital on the patient floor.

i agree JWade with not accepting a 82% success rate but there are patients that just don't want to be intubated no matter how hard you want to intubate them. Rescue airways are there for that reason.

[stcommodore]

I believe that approx four of my missed tubes were sucessful intubations by my partner. Another was a field ROSC and the attempt was one attempt made en route to the hospital and later managed with RSI in the ED. If I remeber correctly one other miss was a code we intercepted a BLS unit on within 2 blocks of the ED, so the "well controlled" ETI attempt didn't really take place. I would argue that if you have no specific numbers/studies/etc to add where do you asume what sucessful % is the norm. Like it was said before each intubation sucessful or not is a learning expierence not only in putting the tube in the hole, but the flow of the incident, equipment you use, patient posistion, etc.

[medic82942003]

Both my codes were At night, I work in a inner city- lots of afican americans- In dark skinned people

of any race Its hard to see blue mottling on the trunk at night in the dark- with just a small flashlight.

Found out about the lividity after I tried to open airway, jaw was very difficult to move. Also I work in detroit MI. Our protocols are we work everyone unless obvious mortifcation. Also our med control doctor

does not think too highly of medics. About a year ago we just got pain meds in our drug box. Detroit

recieving is a teaching hospital for doctors and they want the interns to see and do alot for the patients.

Technically we cant ask permission to terminate efforts. Our protocols are way behind the times. Just about all surrounding counties think the medics from wayne county area bunch of morons due to our limited protocols. The odds of use getting RSI in our protocols are slim and none. I have a new job waiting in Florida, in aboyt 2 months I will be in a better situation. Thank God.

[HERBIE1]

I honestly have no idea how many ETI's I had this year. Guessing around 25-30? Funny thing is, the last 3 saves we had with ROSC, all walking out of the hospital with no deficits- were WITHOUT ETI's- only used a BVM and an oral airway at most. I think I missed 2-3, and my partner got those.

I'm not nearly as enamored with ET's as I used to be as a new medic, or even just a few years ago. As long as you are properly ventilating the patient, for short term, in my experience ET's are overrated. If you have ROSC, then protecting the airway means ET, but good BLS ventilations and aggressive ACLS is the key to good outcomes.

[Redcell19512]

I did two intubations this year. Got both on the first attempt. One cardiac arrest in the field. One with pneumonia in the ER (my service medical director was the receiving physician in the ER. He let me use the Glidescope on that one).

Some of the medics I work with have 8-12 intubations. They also work 7 days a week with several different agencies. I only have one job.

According to my Service Medical Director the paramedics in Pennsylvannia average <1 intubation per year. There are some very rural areas utilizing volunteers who work other careers for their "real job". He also tells me the statistics are flawed because they are counting paramedics who are no longer practicing but are still certified (we are certified forever). So I have no idea what the average paramedic is doing.

We have no access to an operating room. We have an annual skills review conducted by our medical director. We intubate the same dummy every year. We should probably make him a DNR, he's looking pretty rough these days.

[ambodriver]

I'm around 11 or 12 and one surgical cric. 100%.

Another guy at my station has like 20 or so, right place right time I guess