LMAs

[akroeze]

How is it that LMAs are being used in the field BLS when the pt has to be NPO because the LMA doesn't protect against emesis. Also do you have the ability to autoclave them for reuse

Uhmm.... ah.... disposable LMAs?

[chbare]

Xnekal, this bring up a point that I have commented on in the past. It seems that people do not understand the purpose of using a LMA in the prehospital environment. The LMA is a rescue device not a primary method of airway management. True, the LMA offers little to no passive aspiration protection; however, we use the LMA as a temporary emergency method to establish some kind of airway in the patient with a failed airway. (This also includes a cannot mask ventilate situation.) In most cases we are talking about different situations when we compare OR and prehospital LMA uses.

Take care,

chbare.

[arctic_myst]

I forget what company it is but they have a new tube coming out now. It is one single tube, one single air port, and it looks so much easier. You slide the tube in the gullet, fill the balloon for a seal and it is done. It occludes the esophogus and has an airport that sits a few inches above the balloon. When you try to ventilate, if it is difficult, you just back the tube out a little and 9 times out of 10, you end up with a patent emergency airway. Let the hospital worry about the ET's. They have the time and the manpower for that stuff. We don't always have that kind of time. Think about it this way...in a code situation, you need to get an airway, establish IV/IO access, and get a monitor on them before you ever even get to the scene. LMA's and the like are basic airways and can be done by basics. That saves the medic a lot of time.

[Redcell19512]

In all honesty if you are trained to intubate why bother with the combitube.

I hear this from paramedics all the time and it disturbs me. Just because you are trained to intubate does not mean you will have a 100% success rate. There will be patient's that you simply will not be able to intubate. Hence the use of back up devices.

[paramedicmike]

I hear this from paramedics all the time and it disturbs me. Just because you are trained to intubate does not mean you will have a 100% success rate. There will be patient's that you simply will not be able to intubate. Hence the use of back up devices.

AK's tag line comes into play here.

"Training teaches you many ways to skin a cat. Education teaches you it might not have needed to be skinned in the first place."

Anyone can be trained to place a tube in a certain place. The educated provider knows and recognizes when it may be difficult to place the ETT. And there are times when it can be very difficult, for a variety of reasons, to place an ETT. Furthermore, the educated provider knows when to stop screwing around and go to the backup airway.

Which is exactly, as Redcell astutely noted, why we carry them.

-be safe

[chbare]

Arctic_myst, it sounds like you are talking about the King. The King looks to be a very promising rescue device; however, it still suffers from the same problem as all of the other rescue devices with the exception of the LMA Fastrach and a few others that allow for intubation. (When you use them to intubate the trachea) These devices seal the airway above the glottis. This is why we may call these devices supraglottic airway devices. Any subglottic pathology may render these devices useless. (obstruction, burns, trauma, spasm, neoplasm, etc.) I agree that they can help establish an emergency airway and I would even go as far as saying that in most patients you could get by using these devices as a primary airway management method; however, a tube in the trachea or through the neck will still provide the most secure airway and may be the only way of securing the airway with specific types of pathology. We cannot simply write off intubation and expect to use rescue devices as primary devices. (There is a growing number of people who think otherwise however.) The importance of having a well educated and properly trained airway provider who can use all airway tools to their advantage is the key. Those of you who have seen these airways fail and have had to tube around these devices or transition to a surgical option are well aware of the pitfalls of relying on a single airway management strategy.

Take care,

chbare.

[arctic_myst]

I couldn't agree with you more. ET is still the single best and most secure airway. The ECC guidelines that were just released this last year place tubing on the back burner to making sure we get effective CPR and oxygenation. I still think we need to do everything we can in the time allowed to make sure that person recieves the best care possible. I am sure you would agree. Thanx for the other info ont the King. Greatly appreciated. Later.

[Pro_EMT]

Do any other deparments (bls) use LMAs. I like the combi-tube but it is what I was taught. We can only use them in code situations. Although I have not used one in the field, it just doesn't feal right?? I can't explain why.

What do you think?

The use of NJ EMT using LMA is prohibited however i did much research and have inserted them in when i vollunteered at the hospital. The think the use of LMA are quick and easy and require no scoping were the ET tube does.

I feel BLS should be able to make a smooth transfer of care in the prehospital setting. The use the LMA's inserted by BLS prior to ALS arrival would be great due to the fact that once the LMA is inserted you have a secure airway and the ALS provider does not need to remove the LMA nor does he have to scope the airway it gets inserted through the LMA WHICH IS QUICKER!

So as BLS, and BLS in NJ i feel we should have the use of them i think the USE of LMA by BLS in the systems its used in should continue to do so.

[chbare]

Pro_EMT, I suspect that many services choose not to use the LMA because the LMA has many pitfalls. They include:

-Easily dislodged: The LMA is easily dislodged and requires constant attention, something that is difficult to achieve at best in the pre-hospital environment.

-Low pressure seal around the glottic opening: The LMA provides little aspiration protection.

-Low airway pressures: With peak pressures above 20 cm/H20, air will bypass the seal and enter the gut. This further increases the risk of aspiration.

The design of the Combitube seems to be a little more favorable in the pre-hospital environment because you can ventilate with slightly higher airway pressures, it provides additional aspiration protection, and the self seating action of the proximal cuff makes the ETC less prone to dislodgment. While I actually like the LMA and agree that it has definite advantages in the controlled setting of the OR where you have a fasting patient, I would urge you to do a little more research and consider some of the pitfalls of using the LMA.

Take care,

chbare.

[Pro_EMT]

Pro_EMT, I suspect that many services choose not to use the LMA because the LMA has many pitfalls. They include:

-Easily dislodged: The LMA is easily dislodged and requires constant attention, something that is difficult to achieve at best in the pre-hospital environment.

-Low pressure seal around the glottic opening: The LMA provides little aspiration protection.

-Low airway pressures: With peak pressures above 20 cm/H20, air will bypass the seal and enter the gut. This further increases the risk of aspiration.

The design of the Combitube seems to be a little more favorable in the pre-hospital environment because you can ventilate with slightly higher airway pressures, it provides additional aspiration protection, and the self seating action of the proximal cuff makes the ETC less prone to dislodgment. While I actually like the LMA and agree that it has definite advantages in the controlled setting of the OR where you have a fasting patient, I would urge you to do a little more research and consider some of the pitfalls of using the LMA.

Take care,

chbare.

Im not disagreeing with the LMA has its fault- its primary use was for in hospital use to put people to sleep for surgury- HOWEVER as an EMT-B were limited with out training specially with the bullshit in NJ. They dont even want us to check blood sugar because its "too invasive"? The LMA does not take a brain surgion to insert- like everything its practice and perfecting. Ive used them serveral times in the hospital under doc's orders and they are very quick and efficient the key is to get them in on a code before the person vomits because i would assume it would be very hard to get a seal. Ive done the research on it and spoke about it with my doctor (my uncle). The problem with EMS is that every state is on a different page and they have to unify the EMS system across the nation. What do you think?