richard_pfister

I guess I missed the memo where there was a minimum number of posts before commenting on the merits of a particular approach. MCI happens every day in the US. Standards are not opinions. If it's research proven, then I'm all for it. If you want to cite a resource other than assumptions, I'd love to see it. I am not opposed to anything that works and is proven in research. But I'll grant you that it's overly offensive. A better way to say it would be "I'm extremely skeptical that using a condom is a wise idea."

We do. I think the condom idea is absolutely stupid and gives a false sense of cleanliness. If your post-intubation procedure is difficult, deviating from estabalished practices isn't the answer. Disposable blades, a streamlined cleaning process are just two options. It's not difficult to leave a blade in some approved cleaner for a short time after cleaning gross debris. The disposable blades are green and feel a bit odd until you get used to them. They're a lot lighter and you'd think they'll break, but I've grabbed on them and pulled quite hard. They hold.

There's a significant study going on in the Northwest regarding the use of hypertonic saline versus normal saline versus hypertonic saline+dextran in specific patient populations. Issues of informed consent were done in a fashion that passed multiple levels of approval. The goal is to determine whether administration of a limited amount of hypertonic solutions improves the outcomes for trauma patients. Limited research is inconclusive with some studies saying no, others showing that hypertonic solutions inhibit an inflammatory response thought to lead to patient deteroriation in days post incident. If patients need additional fluid, they are to receive standard solutions. This is a single-dose item.

Just sort of jumping in the middle of the price, I picked up the Classic II SE. It's okay. Not great. I will never again get a dual-sided stethoscope for pre-hospital use. Even if the head has a rotating face, you still get tons of background noise into the scope. I have had better luck with those cheapo single-sided stethoscopes that come with BP cuffs in the back of the truck for BPs. I have a big problem with the rubber non-chill ring and the diaphragm coming off the Littman. This sucks because it's not usable without the diaphragm, and that replacing it costs about $5 each time. As far as breath sounds, I've not noticed any appreciable difference between the mid-line littmans. In the hospital yesterday, the RT had a cheap littman. Some aluminium thing that was really flimsy and lightweight. About a $30 stethoscope vs the $62 the Classic II SE goes for. Guess who was better at getting the nuances of lung sounds. Not me. Part of it is obviously skill with discerning adventitious sounds from normal sounds, and part of it is placement. Just a little movement around can make a huge difference. But there's so much subjectivity. I have seen experienced CCRNs and physicians argue amongst themselves about whether this or that sound exists and to what level. The flight medics like the Littman Master Classic IIs. If anyone knows about ambient noise, it's them. Half the time I get BPs that aren't very reliable anyway, and I hate walking in convinced that the pt has a BP of 140/88 only to see it be something different on the machine because I was fighting the noise. I have seen other medics do it. I like to palpate the BP if it's really noisy and not futz with the half-assed approach. All I really need is the systolic in many situations. If nurses and doctors want to bitch because my pressures weren't spot on, they're welcome to come for a ride and see how they fair. Lung sounds are part of the overall patient assessment; they're not the be all end all of it. I think that in some cases, getting a $50 scope, and spending the other $100 on continuing education would be of more use than a $150 scope. As heart sounds go, I'm not going to put a stent in pre-hospitally or listen for regurtation. If they're present and match the palpated pulse, that's okay with me.

I guess I'm curious what the major problem is with the Combitube. Is this going to replace the combitube, or be an additional rescue airway? The King has the advantage of being a little smaller than the Combitude, and only requiring one syringe and one inflation instead of the two balloons the Combitube requires. It's not as established as a tool of choice in the failed airway, but that's because it's just not as common.