Supraglotic Airways and ICP

[usalsfyre]

We provide Prehospital Care not Medicine. In NYS, that is. We are Practitioners of Prehospital Paramedicine not Medicine. A Nurse/RN doesn't practice Medicine. A RN practices Nursing. They are Practitioners of Nursing Care. BLS and ALS are Prehospital Care in NYS, that is. Can't argue something that is fact in one region. I'm disputing other's idealism because I'm not from there, so I can not. EMS as a whole is not egocentric; we are different and the needs are different (for the most part). Medicine are for Physicians... Nurses and Allied Health Professional practice a sub-category of that... Ridiculous is a strong word...

It's all medicine. As you said you can throw it in different subcategories, but at the end of the day, it's all medicine.

ALS/BLS IS ridiculous. You think a physician, PA or nurse thinks "ALS before BLS"?

Sometimes I can fix an airway by moving the patients head. Other times it may take pulling out a scalpel right off the bat. What "level" of care I'm providing falls nowhere in my thought process.

[paramedicmike]

EMS as a whole is not egocentric; we are different and the needs are different (for the most part).

Aside from your longer, contradictory post containing apples to oranges comparisons, this comment struck a cord.

I'm not sure what you mean by EMS not being egocentric. Some of the biggest egos I've encountered have been EMS providers. But overall, EMS, no matter where you are, is not different. The needs are not different. The medical care we provide is not different (save for minor, generally inconsequential protocol differences). The care provided, the goals of the care provided, is/are the same no matter if you're in downtown Manhattan or the middle of the bush in Alaska.

We all strive to stabilize our patients, alleviate their symptoms by providing medical care (which involves practicing medicine) and deliver them to the hospital in one piece (or at least in as many pieces as we found them) and hopefully feeling better than when we initially made contact with them.

This insistence on dividing EMS into different factions serves no one. It doesn't serve our patients. It doesn't serve us. And the sooner we stop playing these us vs them games within our own ranks the better off we'll all be.

[tniuqs]

Interesting yet another supraglotic vs ETT with / without RSI and an airway question.

Well the bottom line is that ALL these procedures can and will cause noxious stimuli this "can" cause increased ICP, heck moving a patient from bed to cot patient can as well. Why, Oh Why, do we focus on these things when we KNOW that RSI or facilitated intubation is "gold standard" although I do believe etomidate has been studied and proven, just how, well I have no clue.

http://scholar.google.ca/scholarq=etomidate+mechanism+of+action+in+ICP&hl=en&as_sdt=0&as_vis=1&oi=scholart

I can go into more detail about a study I was personally involved in ICU and guess what, 50 ugs of Fentanyl and 50 mgs of Lydocaine IV proved that prior to suctioning and nursing procedures this was effective not incure spikes in ICP (provided the probe was not to open to drain because you could not monitor) I will look for the published study when I get a minute for the non believers.

Thing is the ONLY way that one can prove increases in ICP is buy monitoring ICP with a probe in place and this requires some form of anesthetic to be administered to actually secure an AIRWAY and BEFORE a hole in the skull can be drilled, my point being its really a mute point if you need to protect an compromised airway or non effective breathing, JUST DO IT.

If your an basic life support trained provider and licensed and you have a supraglotic airway you use it, if your an advanced life support trained and licensed provider then ETT, because its superior overall, nuff said.

So is a supraglotic airway more or less stimuli than ETT or OPA or NPT airway ? .. my personal opinion would be YES its just common sense really, more area's of pressure = more uncomfortable, tis highly unlikely this type of airway would even be considered in modern day medical practice in any hospital prior to ICP probe insertion or even bother do undertake any research to that end.

Are you going to treat high suspected ICP in the field, well not any more as the whole topic is quite a bees nest these days, Neuro ICU post CT only ... well in my hood. Hyperventilating is a thing of the past proven to decrease positive outcomes, accept when your patient is coneing and you have nothing better to go.

For the statement in a prior post, ETCO2 is equal to PaCO2 in the normal lung this is absolutely false ! .. Vd/Vt = PaCO2 - PetCO2/PaCO2.

On to RSI in E(can I say M?)S, just how can we prove or disprove this with the trend based on a few studies in US suggesting it is not beneficial ... well I have these drugs and I use them, and would prefer to decease the WOB / pre arrest in the circling the drain demographic, and have been quite lucky so far.

[NYCEMS9115]

I want to apologize for going off topic.... PHC Providers; need to apply an appropriate collar. Poorly fitted collars allow for movement. Driving to the ER needs to be as smooth as possible; avoid excessive speeds, sharp turns, potholes, curbs, aggressive stops, etc... When assisting ventilations; do not hyperventilate; do not forcefully ventilate; do not force an OPA in. Avoid excessive movement of the patient. Placing the patient in reverse trendelenberg as a unit on a longboard.

All this will minimize increase ICP in patients with Head Injuries. This is basic management in the Prehospital Phase of "Medicine"...