richard_pfister

Wow, how nice of you to come here with your 4th post on this site and display our standard American narrowmindedness and rudeness. You can not call the condom idea stupid when you have never lived or worked in a country other than the US. Basically you have insulted a very well respected paramedic and member of this site who has seen more trauma casulties and fatalities in a years time than I have seen in my entire career. We have no concept of MCI in the US cause it happens so rarely. Over there, it is a regular occurrence and it is massive. The injuries seen are unlike any we have seen on our homeland. It just doesnt happen here...not yet anyways. Due to the amoount of trauma they see on a regular basis, it would be safe to assume that they have perfected what works and doesnt work for them. Just because it is different from our standards, does not make it wrong. They have improvised and adapted and are doing well with their solutions. Do you have a better one? Are you willing to go over and see that it is implemented? Until such time, we should not criticize another countries ways or techniques, only learn from them and see how we can improve ourselves.

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."

Does anyone use disposable blades? Use once and toss....kinda like a cond....okay, I'll stop right there. :oops:

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.

I was part of a team caring for a step one truma where we required airlift northwest and one of the first things they brought out was a 100ml bag labled hypertonic saline for trial use only. Has any one else run into this. What is hypertonic saline and I thought you had to have expresed consent to use trial medications. Any experience and information would be apreciated. Plus I''m interested in the legality of its use.

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.

I think it's all based on personal preference. I would recommend borrowing as many as possible. I do not hesitate do ask an ER nurse for their stethoscope to listen to lung sounds one last time before turning over patient care. Especially if it looks like a nice one. (Stethoscope not nurse!)

I borrowed a particularly nice electronic stethoscope from a (hot!) nurse and it worked great! Especially considering my hearing deficits (from ^&%$##@& sirens all these years!). I can't remember the exact price but it seemed reasonable considering the quality. Of course, it wasn't in the back of a moving ambulance.

My stethoscope is the best. It's a cheap-o Littman. The best part is: it was free! Unclaimed in the back of a rig for two weeks, and no messages from anybody about a lost stethoscope.

I prefer the littmans compared to the cheapie spragues just because of the soft-seal ear pieces compared to the nasty hard ones of the cheap-o's. Gets a better seal, etc. as mentioned before. Plus, on spragues, the separate tubes have a tendency to bang into each other in the back of a moving rig.

RidRyder, calling someone a "whacker" just because they want/have a nice stethoscope is like calling someone an idiot because they spent $100 on a nice pair of boots. You get what you pay for.

ug

p.s. I understand the reason behind putting entire articles in threads but isn't there a way to get the Cliff's Notes version and post the link too?

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.

Does anybody have first hand experience using this airway as a backup/rescue device. My National Guard unit is looking at using this airway. We currently use the combitube. I have used the King LT on an airway simulator and found the device easy to insert and use, however, this is not even close to a real person. I have googled and found research on this device, and it seems to work pretty well in the controlled OR environment. From what I have found it seems to provide a better seal than the LMA. The manufacturer boasts a seal of 30 cm of H2O verses a seal of about 20 cm of H2O with the LMA. However, you know how the maker of a product likes to brag about their product being the latest and greatest gizmo. It looks like I will get a chance to use the King LT on cadavers next month at SLAM, but I was just curious if any one had any first hand experience with this device. A web site with allot of info about the device is, http://www.narescue.com. However, this company is also selling the device, so I tend to be a little cautious regarding the info they put out.

Thank you and Take Care,

chbare.

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.