How Do You Intubate While Ventilating?

[AnthonyM83]

My partner mentioned he's going to a PHTLS class that says they teach how to intubate while ventilating a patient?

Any idea what they man by this? Obviously you can't have the face mask on and put a tube down at the same time...so maybe they mean you can intubate in between the breaths?

Also, I read someone here say a good medic can intubate while CPR is in progress? I know little about intubation, but does have to do with just skill level or learning special technique? B/c all the medics I've worked have asked me to stop so they could intubate.

AND while I'm asking questions on the topic:

You guys know of any good online resources with pictures on intubating? I don't know what anything in thosei intubation kits do...it'd be nice if I did, so I could hand stuff to the medics (in the proper way, holding from the proper end, in the proper order) or better assist in anyway during codes.

[vs-eh?]

My partner mentioned he's going to a PHTLS class that says they teach how to intubate while ventilating a patient?

Any idea what they man by this? Obviously you can't have the face mask on and put a tube down at the same time...so maybe they mean you can intubate in between the breaths?

Also, I read someone here say a good medic can intubate while CPR is in progress? I know little about intubation, but does have to do with just skill level or learning special technique? B/c all the medics I've worked have asked me to stop so they could intubate.

AND while I'm asking questions on the topic:

You guys know of any good online resources with pictures on intubating? I don't know what anything in thosei intubation kits do...it'd be nice if I did, so I could hand stuff to the medics (in the proper way, holding from the proper end, in the proper order) or better assist in anyway during codes.

1. You can't intubate a patient while actively ventilating.

2. The newest ACLS guidelines recommend breaks in chest compressions to be as brief as possible. Ideally chest compressions should continue through the intubation process. In practice however this doesn't always occur.

3. Any paramedic that is PREPARING to intubate a patient should always have the items by their side/patient's head. They do not really need anything handed to them, besides the tube. PREPARE, is one of the 7 P's used in the Wall's Manual of Emergency Airway Management. If you are still keen, remember SLOPES...

S - Suction, Stethoscope

L - Lube, (Lidocaine), Laryngealscope

O - O2, OPA

P - Position (pillow), PPE

E - Endotracheal tube, ETCO2

S - Stylet, Sticky stuff (tape, tube holder), Syringe

[Scaramedic]

I just recently took a PHTLS course for re-newal and I don't remember anything about intubating while ventilations are going on. Like VS said it can't be done unless someone has come up with a cool AMBU/Laryngoscope combo. I think your friend is confusing pre-oxygenation, but who knows.

:dontknow:

Peace,

Marty

[AZCEP]

My partner mentioned he's going to a PHTLS class that says they teach how to intubate while ventilating a patient?

Any idea what they man by this? Obviously you can't have the face mask on and put a tube down at the same time...so maybe they mean you can intubate in between the breaths?

Ask him to clarify this. I've never heard anything like this one. Ventilate, stop for the intubation, begin ventilations.

Also, I read someone here say a good medic can intubate while CPR is in progress? I know little about intubation, but does have to do with just skill level or learning special technique? B/c all the medics I've worked have asked me to stop so they could intubate.

It is possible to intubate during compressions, but it can make things more challenging. If someone is providing cricoid pressure the movement is reduced, but sometimes it makes tube placement exceedingly difficult.

AND while I'm asking questions on the topic:

You guys know of any good online resources with pictures on intubating? I don't know what anything in thosei intubation kits do...it'd be nice if I did, so I could hand stuff to the medics (in the proper way, holding from the proper end, in the proper order) or better assist in anyway during codes.

Check www.theairwaysite.com and www.airwayeducation.com

They both offer programs about nothing but airway management and are well worth the expense. Youtube also has some videos that show the airway anatomy. Just use "intubation" as your search term.

[AnthonyM83]

Found this cool site EMTs might be interested in. Anatomy pages too w/ pictures:

http://www.healthsystem.virginia.edu/Inter.../Intubation.cfm

You can explore other pages there like:

http://www.healthsystem.virginia.edu/inter...tiveContent.cfm

[OVeractiveBrain]

I think what he may have been talking about is the new tool called the Boogie (check the spelling, im not sure). When an LMA is inserted you can bag quite well. LMAs are an easier to device to use than endotracheal tube (i.e. you just ram it in their mouth without a laryngoscope, lifting anything or seeing anything) and, on top of it, its really hard not to get it in right. The Boogie is a long thin flexible instrument, similar to a guide wire (ET tube "stilette") but thicker. By passing it throught the LMA (and into the trachea), remove the LMA, then just slide the tube (while visualizing or not) over the boogie into the trachea, remove boogie and bag.

Now, this is technically not intubating WHILE ventilating, but that process takes about 10 seconds and its guaranteed, opposed to "difficult airways", failures, and general paramedic incompetence. Its the closest thing to "Intubate While Ventilating" i can think of, without performing a cricothyrotomy while BVMing (and you should not do this if you are able to bag).

If you think about it, its oftly hard to put a large metal blade AND a plastic tube into some one's mouth while there is a large plastic mask that seals their mouth and nose attached to a rubber inflated bag as big as there head.

Overactive

[chbare]

Perhaps he was talking about nasal intubation. You are not ventilating the patient, however, you are using the patient's respiratory drive to assist with the procedure. In fact, you need a patient with spontaneous respirations in order to consider nasal intubation.

Take care,

chbare.

[AZCEP]

Overactive, this is but one way to use a bougie, or flexible tube introducer. You can also use it by itself, through your ET tube, or with a number of other airway devices. There are verisions available with an O2 port built into them to allow continuous oxygen delivery, but you are unable to truly ventilate with the device.

Nasal intubation can be done on an apneic patient as well. I've done a couple where access was quite limited due to manpower or obstructions, while the chest was being compressed, I dropped the tube. No, I don't recommend this, but it can be done. I recall seeing a description for a visualized nasal intubation in a textbook some time ago also.

[Thunderchild145]

Here we are practicing intubation while doing chest compressions. That's the only thing I can assume he meant, because I can't fathom how to intubate and ventilate at the same time.

[Spock]

I agree that you can't prepare to intubate while ventilating. EMT's should be familiar with the intubation process in order to be able to efficiently assist the medic during the procedure if needed. Intubating while compressions are in progress is difficult but not impossible. In order to minimize the interruptions in compressions (which we know is bad) I tell people to get their equipment ready and put the laryngoscope in the mouth just before a pause is scheduled. That way you can visualize the cords bouncing around and be ready to pass the tube when compressions stop.

Some will argue that the primary airway in an arrest should be an alternative airway device (King LT, Combitube or LMA) instead of intubation because any of the alternatives can be placed during compressions. I can see both sides to the argument since this would remove most of the intubations done by paramedics which would decrease their skill. I do think we should stop using the term "rescue airway device" in favor of alternative airway device. Rescue airway has a negative connotation. The current issue of Prehospital Emergency Care has a case report of a helicopter crew that decided to intubate while in flight and chose to place an LMA after meds because they felt an intubation attempt would fail because of the cramped flight quarters and what looked like a difficult airway. They ventilated successfully with the LMA.

Anthony This site has several forum topics covering many issues regarding intubation. Reading them is one way to expand your knowledge on the subject. There is also a text called Anyone Can Intubate by Christine Whitten. I have the third edition but I'm sure there is a newer edition.

Live long and prosper.

Spock