RSI

[spenac]

[

According to the literature, they handle 60-80% of airways without them.

Sorry. Couldn't resist.

'zilla

Sadly your right :oops:.

So many in the EMS field choose not to get or stay educated. They get the piece of paper and stop. No wonder so many services are dumbing down protocols. IMHO they should raise expectations and those that are not willing to meet or exceed should be fired. It is crazy that skills that have been the standard since the 70's are being dropped because people are to lazy to get or stay educated. It really seems EMS is going backwards not forward.

[captainstandup]

The age old problem with RSI has been when things don't go as planned. Unusual anatomy, morbid obesity etc are some of the complicating factors with any intubation. Paralyzed patients and and unmanageable airway make for an ugly combination. On the horizon is the possibility of switching from Succinylcholine and Vecuronium to Rocuronium and backing this up with Suggamadex which is a very fast acting reversal agent capable of completely restoring the patient to exactly the state they were in prior to administration of the paralytic, and this in roughly 90 seconds. Advantages of using a single, medium duration agent as opposed to multiple agents include decreased confusion with dosages, reduced expense and most importantly the clinician will be able to revere the effects of the medication if things get ugly.

[chbare]

Yes, as long as the results of testing remain favorable, I think suggamadex may have a definite application with RSI. However, I am not holding my breath. Look at all of the other reversal agents, serious complications can result with their use, so we will see how this new med pans out.

Take care,

chbare.

[paramedicmike]

For some reason I can't post an active link. I think it has to do with the spacing used in the URL. Copy and paste the whole thing to get to the .pdf. If you click on what's highlighted you won't get there. Gotta copy/paste the entire line of the link.

Here's an interesting position paper from the NAEMSP. It might prove to be an interesting read for some.

http://www.naemsp.org/pdf/Drug Assisted Intubation New.pdf

Happy reading.

-be safe

[AnthonyM83]

So many in the EMS field choose not to get or stay educated. They get the piece of paper and stop. No wonder so many services are dumbing down protocols. IMHO they should raise expectations and those that are not willing to meet or exceed should be fired. It is crazy that skills that have been the standard since the 70's are being dropped because people are to lazy to get or stay educated.

And that's the story of how LACoFD lost pediatric intubation protocol.

[spenac]

And that's the story of how LACoFD lost pediatric intubation protocol.

Didn't they also lose 12 lead interpretation?

[AnthonyM83]

Didn't they also lose 12 lead interpretation?

Naw, I think since the start they were supposed to rely primarily on what the machine interprets it as, but double check it themselves....which FEW do...they usually just read off what the machine says "Normal NSR" and that's that. As long as it doesn't say ***STEMI*** they don't SEEM to worry about it.

[captainstandup]

Are you saying they do not intubate pediatrics in LA county?

[Spock]

I got a few chuckles out of the posts so far. I also don't think it should be a standard of care for EMS for all of the reasons outlined.

ER Doc is almost correct on the anesthesiologists ABC's. They have progressed to the point where now the book has been replaced by surfing the internet planning their next vacation! When I'm on call most of my anesthesiologists are smart enough to stay in bed and not get in my way.

On a serious note and off topic I do wish ER's would get wave form capnography. Only two of the ER's in this area have it and one never uses it. This is becoming the standard of care in the ambulances and should be in all critical care areas of the hospital. I am always amazed when I bring an intubated patient into the ER with good wave form on my LP-12 and they check my tube placement with an Easy Cap. Incredible!

Live long and prosper.

Spock

[AZCEP]

On a serious note and off topic I do wish ER's would get wave form capnography. Only two of the ER's in this area have it and one never uses it. This is becoming the standard of care in the ambulances and should be in all critical care areas of the hospital. I am always amazed when I bring an intubated patient into the ER with good wave form on my LP-12 and they check my tube placement with an Easy Cap. Incredible!

On more than one occasion, I've told the receiving physicians that they can confirm MY tube placement with MY capnography only to turn them over, get a signature, then have them rely on lesser equipment.

Pretty comical.