Digital (finger/touch) Intubation

[VentMedic]

http://volusia.org/ems/COMPLETE%20RSI%20INSERVICE.pdf

I forgot to elaborate on this link. This course was taught after Volusia County Florida's intubation success rates averaged 44% for the county during 2004-2005. However, it was noted the ALS first responders that dragged the stats to that level. The Paramedics on the services that transported supposedly had an 88% success rate. There was some discrepancy noted in the data gathering. I believe their stats have improved OR they redefined some of their definitions to determine success statistics.

Edited March 31, 2010 by VentMedic

[KosherMedic]

....and IMHO, I can cut the neck (and have) pretty quick.

Can I call you Speedy Gonzales?

"¡Ándale! ¡Ándale! ¡Arriba! ¡Arriba!"

If the ETT can make it through the cords and you still have a problem oxygenating and/or ventilating, a cric may not make a difference.

Actually, the scenario I was discussing is where one cannot get an ETT and they need to move on to another way to capture the airway of a patient who is suffocating. So, since they cannot get the ETT tube through the cords they need to move on. If I were the person in the vehicle you wouldn't be able to use a BVM on me very well because of my big beard. People who have a difficult airway have a difficult airway and they may need their neck cut to save their life.

I hope the Paramedic who may one day cut my neck open does as little damage as possible. I'd be very happy that they saved my life each time I looked at my scar in the mirror.

VentMedic - You're an RRT and EMT-P, right? What do you think of Walls' manual? Do you think that there are good recommendations for EMS personnel in there?

[VentMedic]

I have not seen Walls' book.

The text we recommend for RTs is

Airway Management: Principles and Management by Jonathan Benumof.

I have the 1st edition (1996) but I believe there is a 2nd edition out now. It is a very indepth text of 1000 pages the covers some of the airway situations we see emergently, in the ED, ICUs, in the OR and post operatively.

For easy reference with nice pictures, I use:

Atlas of Airway Management; Techniques and Tools

Steven L. Orebaugh

It of course does not go into the detail of Benumof's text but still offers good examples of intubation situations, techniques and equipment. I also like it because if gives new intubators, including residents, a good visual for changing out the King and CombiTube which can be sometimes challenging.

If I were the person in the vehicle you wouldn't be able to use a BVM on me very well because of my big beard.

Yes in a vehicle that might be a problem. However, if I can get into a good position, I have not met a beard I couldn't tame with the BVM. Just don't puke before I get the NG placed. Depending on the situation, I can also adapt my portable ventilator, LTV 1000 or 1200, to do NIV (CPAP or Bilevel) and use a BVM mask with rubber straps that can be adjusted for a very tight seal. You probably won't like it unless it improves your breathing. If I have to intubate you, I can almost guarantee you'll be clean shaven when you wake up in the ICU and I'll swear that you gave me consent for the hair removal before the Versed.

Edited March 31, 2010 by VentMedic

[croaker260]

For easy reference with nice pictures, I use:

Atlas of Airway Management; Techniques and Tools

Steven L. Orebaugh

I have this book, its not bad at all. I do not have the otherone you mentioned.

[VentMedic]

As I mentioned earlier, I like the way Orebaugh's book shows the positioning of the Combitube for changing out to the ETT. Kings, LMAs and Combitubes much come out as soon as possible once the patient is stable. If not, one of the complications is the tongue becomes engorged to where fiberoptic or even a trach may be necessary. If your service just started using these devices on a regular basis, it might be a great idea to inservice the ED doctors in your area especially in the more rural regions. You may even have to assist changing them out. Definitely warn the doctors of the aspiration risks and the potential for trauma especially with the Combitube.

For those using the Combitube, it would really be helpful if you bring the large (140 ml) syringe in with the patient at the ED and personally hand it to whoever will be managing the airway. Not only will this be a great help when they change out the tube but also, if they give you a "deer in headlights" look, you know a quick inservice may be necessary.

Edited March 31, 2010 by VentMedic

[kohlerrf]

I was just reading about this in my respiratory chapter, and it made me curious to see if anyone has done this or would. I have not, and I have had the oppertunity, but frankly, it's creepy to me. So what about you?

I havent found the need to......EVER!

[P_Instructor]

But none of this is covered very well at all in school, nor even Nasal intubation.

I guess I am an old timer. The nasal is an alternative skill prior to the RSI when clenched teeth will hinder the passing of the tube. It is relatively easy after adequate training. I would have your instructors show you how just to have another means to your disposal in airway management. Oral, Nasal, RSI, Cric,......always be prepared for the circumstances you encounter.

[firedoc5]

Had a couple of times where I was going to do that. But I said one more try with the scope first. And I did. So I never actually didn't. When we were being taught it we had a joke that if you tried to do it and they bit down, your new nickname would be "Stubby".

[KosherMedic]

I have not seen Walls' book.

It is unique, as it is a break from the traditional airway book we find for prehospital people that is based on anesthesiology. This book is based on prehospital studies and it attempts to tackle the issues we face "in the ditches".

If I have to intubate you, I can almost guarantee you'll be clean shaven when you wake up in the ICU and I'll swear that you gave me consent for the hair removal before the Versed.

Noooooooooooooooooo! I would NEVER give permission to shave my beard!

I might prefer a hole in my neck...