Conscious Intubation

[Quint7Paramedic]

Hummh...I recall that I have never done a conscious intubation in a "real emergency". What is it like, and what did the patient react like when he heard:

"Calm down, it will be okay, I'm only insert this half-a-foot long tube into you. Then I will inflate the cuff and begin ventillating you. I am a trained professional ( :roll: )."

I would hate to have myself intubated ---conscious.

[OzMedic]

My experience has been that if you are intubating a conscious patient in the absence of RSI, then they will be that sick they won't care what you are doing to them.

[Punisher]

Most of the nasal intubations I have done have been on conscious or semiconscious patients, so yes. In the hospital, I've assisted with several more involved intubations on conscious patients who were obviously going to be difficult cases from an airway point of view for anesthesia.....

[AZCEP]

Nasal intubations are won/lost by inadequate equipment more often than not. If you are going to do these regularly, invest in the Endotrol tube and the BAAM whistle. Nothing available will make it easier to successfully place a nasal tube.

"Conscious" is a bit of a misnomer. If they are conscious, they won't tolerate the oral attempt too well. Unless they make their living swallowing swords, or other, ahem, items. Even with moderate sedation, oral attempts trigger a sleepy patient to come up swinging.

[OzMedic]

I guess I should further qualify my earlier post. The only in-the field intubations that I have performed that would quality in this context have been performed on patients that would be deemed semi-conscious at best such as extremely compromised APO or stroke patients who while not GCS - 15, still have some level of alertness. The others have been in theater that were not indicated for one reason or another for RSI and were performed with the benefit of local anesthetic sprayed into the larynx/phlarnyx to reduce the gag reflex. Having said this I can see where non-facilitated intubation may be performed in the field such as high cervical injuries when the patient is reasonably alert, as poor an option as it may be.

[Punisher]

Unless they make their living swallowing swords, or other, ahem, items.

One of my EMT-B classmates (who is now a flight paramedic for AirEvac last I heard) could drop an OPA on herself....no gag reflex whatsoever. I do believe everyone in class went out with her at least once with the exception of me (being that I was not 18 yet and had a girlfriend and my classmate was 26.....not only was it inappropriate to cheat on my girlfriend, it was also a felony for my classmate).

[Ridryder 911]

For anyone that wants to see a conscious intubation and the use of a whistler device: (O.R. setting) I use this video for teaching my advanced airway class. They are using a fastrach airway then intubationg through it.

http://www.youtube.com/watch?v=HXjPdNSL96c

R/r 911

[AZCEP]

Sweet video Rid!

[rescuecaptain]

Just to weigh in, unless the gag reflex is severely depressed you will have a fight on your hands. Georgia only allows RSI on air services with the exception of a few test studies. In my service we intubate when needed and then and only then we can give versed. For years we used the term "trismus" to get the point across that conscious intubation is rough and barbaric as hell. We as a profession need sweeping reforms to ensure we are giving competent, compassionate care. Fighting with a patient with an intact gag reflex is not compassionate. The John Wayne days should be over. Something has got to give. Just a few thoughts.

[Ace844]

“Quint7Paramedic,”

We’ve had this discussion here many times in various forms…. You could have found this out by correctly utilizing the ‘search function. Here are some links for you to reference involving most things with entubation which also discuss things relevant to your thread!.

http://www.naemsp.org/pdf/Drug%20Assisted%...ation%20New.pdf

http://www.emtcity.com/phpBB2/viewtopic.php?t=4809

http://www.emtcity.com/phpBB2/viewtopic.php?t=4704

http://www.emtcity.com/phpBB2/viewtopic.php?t=3520

http://www.emtcity.com/phpBB2/viewtopic.php?t=4575

http://www.emtcity.com/phpBB2/viewtopic.php?t=4508

http://www.emtcity.com/phpBB2/viewtopic.php?t=4487

http://www.emtcity.com/phpBB2/viewtopic.php?t=3992

http://www.emtcity.com/phpBB2/viewtopic.php?t=4047

http://www.emtcity.com/phpBB2/viewtopic.php?t=3402

http://www.emtcity.com/phpBB2/viewtopic.php?t=2865

http://www.emtcity.com/phpBB2/viewtopic.php?t=3849

http://www.emtcity.com/phpBB2/viewtopic.php?t=2621

http://www.emtcity.com/phpBB2/viewtopic.php?t=3273

http://www.emtcity.com/phpBB2/viewtopic.php?t=2661

http://www.emtcity.com/phpBB2/viewtopic.php?t=3139

http://www.emtcity.com/phpBB2/viewtopic.php?t=3208

http://www.emtcity.com/phpBB2/viewtopic.php?t=3321

http://www.emtcity.com/phpBB2/viewtopic.php?t=1713

http://www.emtcity.com/phpBB2/viewtopic.php?t=231

http://www.emtcity.com/phpBB2/viewtopic.php?t=486

http://www.emtcity.com/phpBB2/viewtopic.php?t=687

http://www.emtcity.com/phpBB2/viewtopic.php?t=1602

http://www.emtcity.com/phpBB2/viewtopic.php?t=1469

http://www.emtcity.com/phpBB2/viewtopic.php?t=1440

http://www.emtcity.com/phpBB2/viewtopic.php?t=527

Get the picture…..?

Hope this helps,

ACE844