Poor Intubations in EMS

[firemedic78]

in the beginning of this thread it was mentioned that the reason we are getting crappy medics is because we are turning out basics that don't think. It was stated that all basics know is 15L NRB, wait for ALS.

I have a problem with this comment. I don't know anyone who teaches that methodology! If it is required to have ALS respond, we teach (around here-tx) have ALS intercept or just haul butt to hospital. We don't tell anyone to just sit and wait for ALS!

Second... with the problem regarding missed ETTs and re-intubations. I am sure it's not just taught here (around here-tx) that if you tube the esophagus, leave that tube and re-intubate with another ett tube...only 1 hole left right?? If you can't put 1 tube in 1 hole... :roll: Oh boy!

Maybe I'm just talking out my arse...but I don't think i'm the only one who knows this technique! We should not have such a high rate of missed and re-intubations!

just my .02

[PrissyEMT]

Second... with the problem regarding missed ETTs and re-intubations. I am sure it's not just taught here (around here-tx) that if you tube the esophagus, leave that tube and re-intubate with another ett tube...only 1 hole left right?? If you can't put 1 tube in 1 hole... :roll: Oh boy!

Maybe I'm just talking out my arse...but I don't think i'm the only one who knows this technique! We should not have such a high rate of missed and re-intubations!

just my .02

You're not the only one... two of my paramedic instructors have also taught us this technique. To be totally honest, I've never used it myself in a real-life situation, but I've had several people tell me it's definitely worked for them.

[Ridryder 911]

Just be sure to be able to document how you ventillated for another additional 3 minutes before re-attempting direct laryngscopy (National Standards) with a tube sticking out of their mouth.....Kinda hard to place the mask on... ?

r/r 911

[nsmedic393]

believe it or not it is possible to tube the esophagus more than once. Its all smooth muscle and alot bigger than the trachea. I have heard rumor that this is a technique but it has been never taught to me and I have never attempted it.

[AZCEP]

Ditto Rid,

Bag mask ventilation becomes dicey with the end of a tube hanging out the mouth.

I will say that I have used this idea on the airway that is destroyed with blood and puke, where visualization was near impossible.

If you are considering using it, consider the fact that before you shove a tube into the oropharynx, you really need to be able to see the glottic opening. Otherwise, you are increasing your chances of damaging the soft tissue dramatically.

If you feel the need to place a landmark, which is all you really accomplish, use an NG/OG tube for it. It's smaller, designed to go into the esophagus anyway, and you can achieve some degree of airway clearance at the same time. In the off chance it ends up in the trachea, you can place your ETT over it.

[Ridryder 911]

Actually, this procedure came from the old E.O.A device. You left the tube in and intubated around it.. now, the reason you could was because the tube naturally went into the esophagus and was inflated with 30 ml of air.. so inadvertent intubations was uncommon. Need to reventillate, was simple.. the tube attached to the special mask to re-ventilate through...

R/r 911

[AZCEP]

You can do a similar gyration with the Combi-tube, but again, this is a different situation.

Now, if you can find a provider that will grab the Combi-tube first, before any attempts at tracheal intubation, I would ask that you introduce him/her to me. That way I can mark it on the calendar, that I have met someone that will do it.

[streethealer535]

I am new to the forum but have a little story to share with you about combitubes and the lack of training at even the I-tech level...

Here in VT we use the Combitube and the EOA as back up airways for paramedics and the combitube for the primary airway for the I-tech level... (no advanced airway aloud at the basic level) I agree that there is a lot of problems with the training In EMS... the other day I was talking to an I-tech that had responded to a "unknown medical" that turned into a working code on arrival... the medic was called and a Combitube was placed... it was pulled by the medic who successfully intubated this patient. Later at the hospital while speaking to the I-tech He was very proud that he got this combitube place correctly.. I was wondering why he was so ecstatic then he told me that he is 1for2 in his combitubes!!!!! I was shocked... how do you MISS with a one shot does not matter where the tube goes airway? he informed me that he could not hear lung sounds in the bases and that he had belly sounds with both tubes... as the conversation went on he said that he use the deflector this time because last time he was hit with.... and I quote "VOMIT FROM THE TUBE" on his last attempt... I almost lost it... He is starting the medic class in the next couple of months... I am in shock that somebody this stupid can even be let into a medic class never mind possibly become a medic... These are the kinds of people that give EMS a bad name and why we will never be considered a profession untill we do something about the education...

thanks for listening to me rant... hope the future is brighter then the present...

JJ

[JakeEMTP]

Welcome to EMT City streethealer535. We look forward to your continued input. 8)

Hopefully, this " I-tech" will see the err in their ways when they start medic classes and learn from their mistakes. I have also been called the eternal optimist so we'll have to see. Bragging about being 1 for 2 with a combi-tube is a sure sign of Paragod syndrome setting in. :roll: I hope medic school will be a little sobering for them.

Again, welcome and enjoy.

[TechMedic05]

Street- Welcome to the City! Enjoy your stay.

Regarding the "I-Tech" - Yes, he is inadequately educated. Severely. I know, because I know exactly who you're talking about. On the brighter side: Maybe it was a good thing in the previous combitube incident that he did remove it. Yes, it is theoretically impossible to misplace, however due to his lacking assessment skills, or poor education, or flat out stupidity, he was unable to determine which of the two lumens were appropriately ventilating the patient, so, instead of potentially ventilating the wrong lumen, he pulled it. Honestly, I'd rather see a completely BLS airway than someone who doesn't know how to assess a combitube ventilating the incorrect lumen. [granted, it would've been smarter had he deflated either of the two cuffs before he pulled it out, but I digress.]

How does a provider that is severely inadequately educated get into Medic School? Go to one that has no formal entrance testing. ::cough:: And also for the graduating class of 2005, a 67% Fail rate for getting to the NR exam in the scheduled amount of time. [9/27 isn't so hot.]

Also, off the record, this Intermediate is never wrong, and yet severely inexperienced.

Maybe more education is what he needs. Or at least some good clinicals with a good preceptor to show just how much of an imbecile he is.