Cribbing The Airway

[dropdeded]

Saw this article on the Jems site, (ok to link??). Really does seem like it may be a simple, effective tool in the field. Thoughts from you guys??

http://www.jems.com/jems/31-11/243890/

ed

[Dustdevil]

:-k

Hmmm... I can't say I recall ever needing such a thing. But then again, necessity is the mother of invention, so I am quite sure that this arose from a need that somebody encountered. Seems logical and functional to me. But in the grand scheme of things, when it comes time to take the dead weight out of my already over-stuffed ALS bag, I'm going to be hard pressed to find a justification for keeping this item in there.

But hey, I don't begrudge anybody using something that works for them!

[hfdff422]

I could see this being a bigger help to BLS providers than to ALS. The benfit for suctioning a conscious patient seems pretty apparent.

[AZCEP]

A device designed to prevent damage caused by sloppy laryngoscopy technique? Great idea, oh wait, that was the idea behind the combitube and the LMA. :roll:

For the BLS providers, I can see this being a good tool. As mentioned, suctioning and airway maintenance would be much easier with something like this in place. Tough to convince someone to spend the money on though.

[brock8024]

I am with everyone else, if you use good intubation technique then you should not have to protect the teeth because the blade is going the other way.

As far as BLS using this to suction, WHY?

You are going to spend how much time putting this in then putting in the light to see the airway when you can suction without it. I personally think someone sitting around trying to make a few bucks.

[Ridryder 911]

Another device for a "whacker" to carry.. I am sure that might even start another EMT level for this... Hey it has a light!..

I am not worried the price will destroy its' future.... as well hopefully knowing how to properly introduce laryngoscopy one should not have to have it ... or more simpler make bite blocks out of tape for pennies...

R/r 911

[NREMT-Basic]

Do you honestly think that responders and agencies that chose to purchase this device are whackers. If it makes damage to a patients teeth less likely, facilitates ET intubations in dimly lit homes or at an accident site at night, increases the ability to visualize the cords or reduce the risk of tracheal or esophageal damage when using a combitube, it seems to me that its not a bad thing. Not to mention that it has the very real potential of making it easier for a inexperienced emt, or anyone for that matter to assist respirations with a bag valve mask since it almost acts like an OPA as well. If you dont like it, dont use it. Im just not sure why you feel the need to call anyone who does something that you wouldnt do a whacker or otherwise insult them. I like ya man, but you should add curmudgeon to your bio. Do you prefer modern ambulances or recycled hearses. And yes, in an ideal situation, the breaking of teeth during an intubation isnt a concern. But why not use something that eliminates the risk altogether. One of my preceptors (a medic) broke a total of 6 teeth on two patients in one shift while i was with him. Expertise and what should happen is great, but accidents happen an I personally am all for anything that cuts down on the likelihood of them happening.

[AZCEP]

Do you honestly think that responders and agencies that chose to purchase this device are whackers.

Agencies will most likely not be buying them. The individuals that buy them would most certainly be as described.

If it makes damage to a patients teeth less likely, facilitates ET intubations in dimly lit homes or at an accident site at night, increases the ability to visualize the cords or reduce the risk of tracheal or esophageal damage when using a combitube, it seems to me that its not a bad thing.

There are already several devices that accomplish this. The lowly OPA for one, the laryngoscope for another. On the outside looking in for most would also be the lighted stylette.

Not to mention that it has the very real potential of making it easier for a inexperienced emt, or anyone for that matter to assist respirations with a bag valve mask since it almost acts like an OPA as well.

The trouble is the OPA needs to be the first option. The benefit of the light to a BLS provider would be limited at best. Even ALS should consider that more light in the oropharynx can complicate visualizing the glottic opening.

If you dont like it, dont use it. Im just not sure why you feel the need to call anyone who does something that you wouldnt do a whacker or otherwise insult them.

The benefit of this device is dubious at best. If someone wants to buy something with limited applicability, and excessive cost over something that is known to work, that makes them what exactly?

...in an ideal situation, the breaking of teeth during an intubation isnt a concern.

And how is it not a concern? Every time you introduce a surgical steel/plastic implement into the mouth, you should consider that you might do damage to the teeth. Even more so to the soft tissue, but the risk is very real. Let me know when you manage an ideal airway. I'm willing to estimate that everyone that has looked into an airway, that was not in an OR, found something they weren't quite ready for.

Expertise and what should happen is great, but accidents happen an I personally am all for anything that cuts down on the likelihood of them happening.

As are most paramedics and their medical directors. Those people that allow us to continue placing devices into patients want to be sure we know how to use the devices that have been around long enough to prove valuable. This device is not going to do any better job of airway management than the OPA does, even with the higher cost. Become proficient with the OPA and BVM that you have available to you on your response unit.

[Ridryder 911]

Do you honestly think that responders and agencies that chose to purchase this device are whackers.

Yes, much rather for them not to spend $4.00 on a device (in which I am sure you have to buy a box full). You won't be able to bill for them, and if you pry or using a "fulcrum" method to intubate then you are improperly performing the procedure. I have seen a midget anesthesiologist intubate many times and if they don't need to pry, no one does!

.... facilitates ET intubations in dimly lit homes or at an accident site at night, increases the ability to visualize the cords or reduce the risk of tracheal or esophageal damage when using a combitube, it seems to me that its not a bad thing....

Well first of all why would one need to have a light for a blind intubation technique in using a combitube? Second, how is a blinding light going to increase my visualization in oropharynx versus the hypopharynx when in actually a dark background is better... (see link to video)

If you dont like it, dont use it. Im just not sure why you feel the need to call anyone who does something that you wouldnt do a whacker or otherwise insult them.

Has this device been approved by the FDA, or field tested, where is the scientific data that backs up their claims?

One of my preceptors (a medic) broke a total of 6 teeth on two patients in one shift while i was with him.

Glad I am not their medical director or better they should be glad I am not their medical director. In my nearly thirty years, I have only seen 2 teeth broken off a partial plate. Either they need to RSI, or learn proper positioning, there is NO reason that should had occurred, especially that often. I would definitely investigated why?.. and yes, we are busy enough we enough to intubate daily, as well and have patients with poor L & M scores. I would hate to be their EMS insurance provider.

Now, let me ask you .. do you know of the Amway rescue choking removal device, the suction/laryngoscope blade, CPR glove ?.... Want to know why? Because they were all designed with good intention and yes even with some great success, but this does not make them marketable and long lasting.. EMS services are aware of this, that is why administrators would rather for those to intubate make bite blocks with tape, for 15 cents and perform the procedures with ease.

Want to see how new devices are tested and should be marketed.. here is a neat new laryngscope. We have used only a couple of times, there is no "prying on teeth, you will see actual intubation process, and even has a "heating element" to eliminate the "fogging" of the lens, and yes it is disposable or can be "cold sterilized". We have used them on trauma, spinal injuries (no movement of neck needed, and small grades of posterior pharynxy.. the problem is the cost at $100.00 each.. thus, you will not see them until they get cheaper... http://vam.anest.ufl.edu/airwaydevice/airtraq/index.html ahttp://vam.anest.ufl.edu/airwaydevice/videolibrary/airtraq3p15.html#simnd video

They still need to be studied for effectiveness and worthiness...

Sorry, not to "pop" the bubble, but just because it appears neat.. does not make it worthy...buy it if you want to, just don't expect your service to.

R/r 911

[NREMT-Basic]

Well since I disagree with you on almost every counterpoint you make, i wont address each one save to say that I have used a earlier version of this device which was not as refined as the current marketed model and it does with ease most of the things you say a OPA does. An OPA offers no substantial protection for teeth or soft tissue, like the soft palate. This device which seals itself to the roof of the mouth like a upper denture plate virtually eliminates the concern over broken upper teeth and eliminates the chance of tearing the soft palate or other tissue. The way the side struts fit into the mouth aides in protection of the cheek tissue and the brackets which fit over the bottom teeth do a fair job of protecting them as well. I have no opinion on the light option whatsoever, though i fail to see how too much light obscures the glottal opening, but ok. In any case, I have used the earlier versions of this device, I like it and have even found that in many cases it provides a more secure airway than an OPA. I agree to disagree and respect your educated and experienced opinion.