In this installment of Office Hours we revisit the series “The Protocol Effect” and discuss airway management. Should this be controlled by written guidelines, clinical impressions or current research? Anyone who has been in the field knows a GCS of less than 8 or 10 doesn’t always mean a patient requires intubation or advanced airway management. Yet many protocols say to do just that. This may just be another time when providers need to prove their understanding of these skills, their need and the patients we treat. Take a listen to this episode and tell us about your guidelines and how you interpret them.
Listen to the Standing Orders podcast on The Future Of Airway Management here.
OK, the argument on pre hospital intubation has been going on for some time now. Should we or shouldn’t we. How do we train, remain competent and prove that we can do it, successfully every time. Is that 100% success rate a realistic number? What have you done to improve your success? What can be done as an industry to improve and prove our success?
Thanks to Sean M. Kivlehan, MD, MPH, NREMT-P for calling in. Be sure to take advantage of Sean’s CE articles over at EMS World – Continuing Education Articles
Also thanks to Garth from the EMS blog Drug-Induced Hallucinations for sending me some great info and feedback on this topic.
Check out RogueMedic.com for some pre hospital intubation posts that are sure to get the juices flowing.
Finally, here are some articles on the topic that are of interest.
No difference in the time needed or success rates between ETI or King airway: http://www.ncbi.nlm.nih.gov/pubmed/21763247
Paramedic RSI improves neurologic outcomes at 6 months: http://www.ncbi.nlm.nih.gov/pubmed/21107105
Dutch paramedics have a 95% success rate at ETI, even with a low overall number of intubations. ETCO2 is strongly recommended: http://www.ncbi.nlm.nih.gov/pubmed/21612142
Policy Statement from ACEP cautiously supporting prehospital RSI: http://www.acep.org/content.aspx?id=29188
This quick video gives an overview on the differences between MacIntosh and Miller laryngoscope blades, their placement and use in endotracheal intubation. Great for a quick refresher and new paramedic students.
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When it comes to skills in EMS, pressure to do well especially in front of your co-workers can be stressful. Things like IV access, drug selection and clinical impressions can leave your co-workers with either a positive or negative view of you. Sometimes worrying about this perception can dictate this view more negatively than you think, IF you’re not thinking.
Get the Uncovering Difficult Airways report free by clicking here.