Intubation in Cardiac Arrest - Spin Off From Pain Mgmt EMTB

[mikeymedic1984]

There was some discussion in the other thread about intubation no longer being warranted in pre-hospital cardiac arrest, which was news to me. Some of us cited that protecting the airway and providing oxygen straight to the lungs was beneficial, whereas others cited that there are no studies that show that intubation has any effect on survivability, which makes sense because there is such a small percentage of those who survive regardless of what you do. So let the debate begin.

[ERDoc]

I wouldn't make much out of that conversation. Kiwi lives in a country that is upside down, so they probably practice medicine backwards there, too.

[Kiwiology]

I wouldn't make much out of that conversation. Kiwi lives in a country that is upside down, so they probably practice medicine backwards there, too.

You know what, we do practice medicine backwards, we take in a little money from everybody in terms of tax and allow everybody to get health care for free! Such a crazy idea ...

I can't be arse'd typing up a thing right now

Man my tooth hurts, I wish we practiced dentistry backwards too last time I went to the Dentist it cost me $400

[DwayneEMTP]

It might be easiest if you posted some current, peer reviewed evidence that intubation in arrest is warranted and productive.

[ERDoc]

You know what, we do practice medicine backwards, we take in a little money from everybody in terms of tax and allow everybody to get health care for free! Such a crazy idea ...

Stop being such a communistic socialist. This is America, home of the freem land of the brave. The only ones we give handouts to are the politicians.

[croaker260]

I think its important to identify the two major problems with intibation in the arrest setting.

Problem # 1: Inturruption of CPR

Easily fixed. Intubate during CPR. When we STOP stopping CPR to intubate, this is not longer n issue and becomes simply an acedemic debate.

Problem # 2: Missed intubation (regardless of case)

This has been discussed EXTENSIVELY before. Without rescusitating that dead necrotic horse, I will simply say that this is also an easily solved problem, but must be solved at all levels. Not just OR on live patients, but realistic airway management scenrions, and realistic airway management training intially. I wuld LOVE to see an AIRWAY MEGA-CODEfor the NREMT using all types of devices in a systematic approach instead of a BS AIRWAY station that looks at unealistic intubation on a table..

I applologize for the short post, But I am between teaching. I am sure I will post more later after the flaming begins.

[Kiwiology]

The big problems with intubation during cardiac arrest are the interruption of CPR and decreasing venous return to the heart by increasing intra thoracic pressure due to inadvertent hyperventilation

No evidence has been presented that intubation improves outcomes to neurologically intact discharge and there are far more important things to focus on during cardiac arrest than shoving an endotracheal tube down somebodies gob

[ERDoc]

http://www.ncbi.nlm.nih.gov/pubmed/21985431

A Japanese study from 2011 that showed no difference in neurologic outcome between endotrachial intubation and supraglotic airways. It did show that early airway management improves neurologic outcome. Some criticisms I have is that is does not have a study arm that did not receive advanced airway management.

[mikeymedic1984]

How would you hold that study in the US ?  Any city that chose to throw away their laryngoscopes would be swarmed upon by the lawyers.  He did not die because of that massive aeoritc aneurysm, it was that medic who only used a BVM to ventilate him, instead of the gold standard that has been around for over 30 years of EMS ?????P.S. Kiwi, when you take 40% out of someone's paycheck in the form of a tax, your healthcare is not free. Not saying our method is any better, at least in your world everyone pays something towards their healthcare whereas here, the insured pay for the uninsured.

Edited April 9, 2012 by mikeymedic1984

[chbare]

Who is seriously calling it a "gold standard?" The paradigm has shifted significantly recently. Many lawsuits that I've seen have been due to endotracheal intubation related issues.