I trained on LP10s, and used them for awhile. Hell, I remember humping a LP11. You calling me old?
Speaking of old, I learned on a LP5 in Paramedic school. ;)
Of Airway Management, Intubation, Crics, and tubes large and small
- Thread starter policemedic
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Speaking of old, I learned on a LP5 in Paramedic school. ;)
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My $.02
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I trained on LP10s, and used them for awhile. Hell, I remember humping a LP11. You calling me old?
Maybe
Although, I'm only 30 and that's what I learned on and used as a student...ah the good old days, has it really been 10 years?
pardus
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I heard a rumor that might be dropped soon.
I think having a B is a waste of time, we should be civi qual'd to an Intermediate IMO.
policemedic
Verified SWAT
We could fill an entire thread on 68W training. I'm sure there are plenty of strong opinions on that topic.
policemedic
Verified SWAT
Excellent point, and where I've seen a lot of people go wrong (and not just with airway management). Professionals test their equipment before they use it. Yes, it takes time (hence, why I love to say RSI is not rapid at all), but it's absolutely necessary to prepare and test your equipment. I can't tell you how many times I've heard someone curse when they found their laryngoscope bulb was dead (I'm dating myself, I know) or loose, or the 'scope simply needed new batteries.
"Ok, we're almost done. Take a big, deep breath..." :nerd:
I trained on LP10s, and used them for awhile. Hell, I remember humping a LP11. You calling me old?
Hey D. You talking about the LP-11 that we carried @ good ole Medic-96?
F.M.
I don;t neccessarly think the protocols are that bad but they could be a little more aggressive, such as not having to call for steriods for allergic reactions but have them in standing orders for resp. emergencies. LOL. Thanks god I work in a county that is o.k. and I have a medicla director that is AGGRESSIVE!
F.M.
policemedic
Verified SWAT
Yep. I sooooo much prefer LP12s or the Phillips over that beast.
I am not crazy about the LP-12. I like the Philips but I have been using that for a while so I am used to it. Hell, even Medic-168 went to Philips and we are being in-serviced on them now / I am exempt of course.
F.M.
I'm a little late here, so I will just throw some quick hits for my personal choices for airway.
- Huge fan of the KING LTD. I carry them in my bag. Not my first choice, but great in MASCAS or as a second to last ditch.
- I am not afraid to cric at all, although I do agree with all of those that cite the inherent complications associated with the procedure. TCCC moves you in that direction (for advanced practitioners) pretty quickly. Using lidocaine to numb the area of an awake pt (needle through the cric membrane, big spray and cough for the PT) seems to work well. I've never done it, but I did stay at a Holiday Inn Express once.
- I did chuckle at (I think Policemedics) "I like the King for not interrupting compressions"- isnt that what being REALLY good at intubating is supposed to alleviate? Kidding! But seriously, you should be good at intubating people or just not do it. You get one, maybe two shots at a viable patient, so you better hit it.
- The RSI/PAI (pharmacologically assisted intubation) question is pretty intriguing. For instance, I dont carry Etomidate or any paralytics, so we have had lots of conversations about a good way to put someone down, manage their airway, and keep them down with the stuff we have. One of the answers? Preload pt with 2-4 mg of Versed, mix Ketamine, fentanyl, and propofol in a 500cc bag of saline. Run wide open until pt is down, secure airway, titrate drip of happy juice to "not awake". I wanna stress this is just a conversation amongst the operators and docs/IDMT's, this isn't part of our protocol as it stands. But our medical control is pretty lenient on what we can do, and we bring wacky ideas to them now and again and get it approved to try out. If we cant carry propofol (mostly due to getting our hands on it or how it has to be stored), you can do this with a little more pre-load of ketamine. Everything else remains the same.
Anybody smarter than me (read:everyone) feel free to weigh in on this.
- Huge fan of the KING LTD. I carry them in my bag. Not my first choice, but great in MASCAS or as a second to last ditch.
- I am not afraid to cric at all, although I do agree with all of those that cite the inherent complications associated with the procedure. TCCC moves you in that direction (for advanced practitioners) pretty quickly. Using lidocaine to numb the area of an awake pt (needle through the cric membrane, big spray and cough for the PT) seems to work well. I've never done it, but I did stay at a Holiday Inn Express once.
- I did chuckle at (I think Policemedics) "I like the King for not interrupting compressions"- isnt that what being REALLY good at intubating is supposed to alleviate? Kidding! But seriously, you should be good at intubating people or just not do it. You get one, maybe two shots at a viable patient, so you better hit it.
- The RSI/PAI (pharmacologically assisted intubation) question is pretty intriguing. For instance, I dont carry Etomidate or any paralytics, so we have had lots of conversations about a good way to put someone down, manage their airway, and keep them down with the stuff we have. One of the answers? Preload pt with 2-4 mg of Versed, mix Ketamine, fentanyl, and propofol in a 500cc bag of saline. Run wide open until pt is down, secure airway, titrate drip of happy juice to "not awake". I wanna stress this is just a conversation amongst the operators and docs/IDMT's, this isn't part of our protocol as it stands. But our medical control is pretty lenient on what we can do, and we bring wacky ideas to them now and again and get it approved to try out. If we cant carry propofol (mostly due to getting our hands on it or how it has to be stored), you can do this with a little more pre-load of ketamine. Everything else remains the same.
Anybody smarter than me (read:everyone) feel free to weigh in on this.
"Mercy buttercups" Guys. This nurse has thoroughly enjoyed reading and learning from this discussion.
Each county EMS has a procedure for EMT-B and running ambulance in the Bay Area of California is a tough job. You have to petition each county with your qualifications and then get a photo id to work in each county. This made things hard because out on the Research vessel you were able to and expected to do what the Dr. on the radio directed. Then when working the counties mostly to recert you had to back up a mile on what you could do. Being nationally certified is a big help when in this situation all the counties I worked for accepted this better than individual fire or county certification. hell we would pick up hospice patients with drips of happy juice and couldn't proceed to the next county to their hospital of record because that county did not allow B's to tranports Iv patients. Funny world out there and some great Dr's willing to share what they know. Others not so willing.
one county you could remove objets penetrating the cheek and in others stabilize the penetrating object and transport. Interesting when it is a 6 ton pneumatic press.
This was in the 90's so I don't know if it is that way in other parts of the country.
I was working an ER and had a EMT bring in a patient and he was bagging the hell out of him and you could watch the stomach rise and fall on each squeeze of the bag. Might have missed it sparky.
Infants and toddlers are the worst nothing fits that I carried. Finally a Dr. set me up a small box for children things got easier.
I sure don't miss it to be honest. The only thing bad about retirement is you have to be old to retire.
Bill
one county you could remove objets penetrating the cheek and in others stabilize the penetrating object and transport. Interesting when it is a 6 ton pneumatic press.
This was in the 90's so I don't know if it is that way in other parts of the country.
I was working an ER and had a EMT bring in a patient and he was bagging the hell out of him and you could watch the stomach rise and fall on each squeeze of the bag. Might have missed it sparky.
Infants and toddlers are the worst nothing fits that I carried. Finally a Dr. set me up a small box for children things got easier.
I sure don't miss it to be honest. The only thing bad about retirement is you have to be old to retire.
Bill
policemedic
Verified SWAT
Agreed. I have a strong opinion that 2nd and 3rd tier backup airways are a good thing. I never want to be in a difficult airway situation without multiple options.
Lido is your friend. I think eliminating pain prior to a procedure (blocks, etc.) is a good thing. Of course, when you need that tube in yesterday, there's no time and you just have to cut big or go home.
Nope, that was my brother from another mother. I completely agree with you about being skilled, and getting it done the first time. Anyone who has intubation in their toolbag should also be an expert at assessing the pt's airway and evaluating the chances that it will be a difficult airway. This should be done with every pt, every time. If the decision is made to orally intubate someone with a predicted difficult airway, then knowing that beforehand allows you to lay out your "oh shit" 2nd/3rd tier devices. And sometimes, the best decision is to choose another method/device.
We're in sort of the same situation. Without proper drugs, we (PA medics) sometimes find ourselves in difficult situations. With that said, I'm fully aware of the difficulty associated with implementing RSI in an EMS system.
Move to Greenville, SC. We have had RSI as part of our standing orders since about 2002 and crics for nearly that long... Seem to remember thrombolytics being started about 97-98 time frame too...
Move to Greenville, SC. We have had RSI as part of our standing orders since about 2002 and crics for nearly that long... Seem to remember thrombolytics being started about 97-98 time frame too...
I seem to remember a dude from Greenville, taking a IPIMBA course (bicycle course) @ my squad a few years back. He had his face in the magazine Jems regarding the type of truck you guys use (Wheeled Coach) I believe. Blond with a flat top haircut.
F.M.
policemedic
Verified SWAT
Move to Greenville, SC. We have had RSI as part of our standing orders since about 2002 and crics for nearly that long... Seem to remember thrombolytics being started about 97-98 time frame too...
Must be nice. One more reason to move to the South!
Needle/surgical crics are no issue here, and haven't been for as long as I can remember (as long as you're not constantly doing them; that would ring a few bells). We can use any method we like to intubate, except retrograde (which is a shame). I do believe RSI should be available to paramedics, as long as there is a robust QA/QI program with an involved medical director.
Where lysing in the field is concerned, many squads, especially the volleys in Western PA, didn't want to buy 12-lead capable monitors until they were forced to by licensing requirements. Others simply weren't interested e.g. the Philadelphia Fire Department, and they're the largest EMS service in the Commonwealth. FM and I worked for the first service in our area to use 12-leads, and even there some medics opposed it despite the clear benefits. Additionally, there was much debate about transport times, medic vs. MD interpretation of the 12-lead, etc. With such a varied landscape of opinion, it's not surprising TNK or Retavase never ended up on the trucks.
policemedic
Verified SWAT
Not that this has anything to do with airway, but I meant to mention this yesterday since you mentioned ketamine. It's in the process of being approved and included into PHTLS protocols for pain management.
New thread alert!
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