Difference between airways

[Just Plain Ruff]

So what is the Gold Standard? Is it the ETT or is it the Surgically placed airway?

If I trached a patient in the field have I placed the Gold Standard even though I've never done one before?

I'm terrified to trach someone so I'll probably be so reluctant to do it that I'd sooner give my left testical and right hand but of course I'd do it if left no alternative but I don't think that a paramedic placed trach is a gold standard.

[paramedicmike]

Also, intubation does not prevent aspiration. In fact VAP is a major problem and frequent oral care along with frequent oral suctioning and secretion management are often interventions included in VAP bundles.

Fair point. Obviously, I did not consider VAP when thinking about aspiration complications. I was thinking more about immediate prehospital prevention of aspirated gastric contents.

There are definitely differences to consider when looking at prehospital management versus in hospital management of airway devices.

[chbare]

This is a good discussion. I do not believe a general, gold standard airway exists. Depending on the boundary conditions of the scenario, any number of interventions may be warranted.

[fab]

I do not believe a general, gold standard airway exists. Depending on the boundary conditions of the scenario, any number of interventions may be warranted.

I agree to some extent. Yet ET tubes are improving, reducing the numbers of VAP massively (by up to 70%). Does anyone have first hand experience with tubes such as Tyco's Hi-Lo Evac? I've also heard of one using a different type of cuff which prevents secrete from passing through.

All in all I would still consider them the gold standard (especially in EMS) with the only disadvantage being the extent of training needed to insert them successfully.

[chbare]

You can make anything a gold standard when you apply the right boundary conditions. I'm simply not willing to say one tool is the best overall "gold standard."

[Spock]

Interesting discussion and many good comments. I think the thing to remember is that airway management means delivering your patient to the hospital ventilated and saturated. There are many ways to do that and what may be appropriate in one situation may not work in another. Good patient care is more than just doing procedures.

It's been a while since I've checked out the site but I hope to be back on a more regular basis. Still some familiar names on the site.

Spock

May the tube be with you.

[MikeEMT]

Thank you for the replies so far. When I posted this topic I was expecting a very basic answer. The airway seems like a very simplistic structure. I am continually amazed at how complex our systems really are and what difficulties it presents in the prehospital environment.

The more I learn, the more unsatisfied I become and the more I want to keep learning. One of the best things I like about this profession is how easy it is for us learn from different people and disciplines.

[paramedicmike]

Anatomically the airway isn't terribly complicated. Physiologically, however, the airway and potential complications from (mis-) management can be exceptionally complicated. Effective airway management is something that takes a lot of practice. Unfortunately, many EMS providers look more at the technical skill rather than knowledge required to do it well.