RSI

[spenac]

Well, STOP IT!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! :roll:

Yes Sirrrrrrrrrrrrrrrrrrrrrrrrr. :wink:

[FormerEMSLT297]

I see some contradictions in your statement.

If you are going to risk complications, doesn't it make more sense to do so ten minutes from the ER than an hour away? And, if so, doesn't that make urban a more logical deployment for RSI than rural? And, since it is extremely rare for HEMS to be the first ALS on a scene, why would RSI be more valuable to them than to a primary provider? If I haven't gotten that tube by the time you get there in the bird, it's about too late for you to save the day with teh RSI.

I'm not asserting either of those claims myself. I'm just pointing out your contradictions.

Contradictions, O.K. maybe, my point is that if you can bag a person effectively for a 5-10 minute transport time, thats fine, but if you have a longer transport time you run the risk of creating gastric distention which may impede the resp. exchange, also in our area, the helos usually get to the calls within about 10-15 minutes after the call, so they arent very delayed. Ideally if all systems had the QAI and dedicated training to support it, RSI should be standard, but I just don't see the systems being able to support it.

I know of several jurisdictions that allow the EMS supervisors to RSI, others have certain units that are allowed to RSI, but not all of them.

[Novisen]

I have done about 5000 calls and I still haven´t met a patient that had need for an RSI. Have intubate some of my patients after trauma on vital signs with no medication. If the patient have problem with A or B, RSI is the last thing we try if all others methods have failed.

[ERDoc]

I have done about 5000 calls and I still haven´t met a patient that had need for an RSI. Have intubate some of my patients after trauma on vital signs with no medication. If the patient have problem with A or B, RSI is the last thing we try if all others methods have failed.

I would say that I see about 324 patients per month and RSI at least 1-2 of them. You are either serving a very healthy population or are not using RSI properly. What do you mean "RSI is the last thing we try if all others [sic] methods have failed."? Are you saying that you attempt to intubate without at least sedation? That seems rather barbaric and also dangerous for your patients. Maybe I am losing something in the translation.

[Novisen]

When I intubate a patient with RLS 8 or GCS 3, I don´t use any medication. Give me an example of a patient that needs RSI that has own breeding.

[spenac]

that has own breeding.

I think you mean breathing on their own. If you did mean breeding this must be well some new sick fetish. Some people that are breathing on their own still need airway protected by RSI.

[ERDoc]

When I intubate a patient with RLS 8 or GCS 3, I don´t use any medication. Give me an example of a patient that needs RSI that has own breeding.

I generally make it a rule not to intubate anyone that is breeding. I like to give them privacy. Sorry, I know that is not what you meant, but you can't let a good one like that get by. What about the people with a GCS between 4 and 8? What about a conscious pt with severe facial injuries and bleeding who is having difficulty clearing their airway of blood? How about a COPDer with sats in the 70s who is obviously tiring? Same for a CHFer who has failed BiPAP and is becoming more lethargic. There are plenty of instances where pts are unable to protect their airway and need to be RSIed.

[AZCEP]

Per the Manual of Emergency Airway Management:

1) Failure to protect the airway

2) Failure to adequately ventilate

3) Anticipated clinical course

Much better to intubate early, than to wait until you absolutely have to, only to find that you can't due to underlying pathology.

[ERDoc]

Per the Manual of Emergency Airway Management:

1) Failure to protect the airway

2) Failure to adequately ventilate

3) Anticipated clinical course

Much better to intubate early, than to wait until you absolutely have to, only to find that you can't due to underlying pathology.

Yup, I would much rather have a nice, controlled RSI versus an crash, last minute airway.

[captainstandup]

Here is an example, 52 year old semi-homeless man riding a bicycle near the Middle School. 16 year old kid in dads blazer didn't see the bicycle rider until just before impact estimated to be 35 - 40 mph. Upon our arrival the patient is unconscious with obvious s/s closed head injury but is technically breathing on his own @ 24. Teeth clenched and impossible to open his mouth. Bleeding from nose and to a lesser extent from his mouth as evidenced by blood being forced through his teeth during expiration.