PhillyD

OK, it seems like those who know the most have the least to say about this seminal event. The facts, as I see them laid out; are that there is a company whose predatory business model identifies targets for litigation and then goes to the rightholder and offers to in some way or another, either buy and or sell this information in hopes of financial reward. The whole thing does not pass my instinctive smell-test. Something smells foul and seems unseemly in this whole affair.

I like the Turkell Safety Needle a lot http://bit.ly/bjamsd It still unfortunately, needs a high flow one-way valve like the Hemlich Valve now more commonly called Chest Drain Valve,made by Cook, with connecting tubing. There as a valve inside, but it is only for initial decompression after insertion. Once the stylus is withdrawn, basically so is the valve. I love putting the Turkell and Heimlich with Tubing in clear plastic 2-3" diameter tube about 15" long. Makes the whole kit easily packed without damage to these rather expensive and somewhat fragile components. I remember one of the more striking things I learned working in the ER after years on the street, was that it did not seem like needle decompressions often did much to relieve a frank pneumothorax. The problem is since most people use an IV catheter, they are using a catheter that once the metal stylus is removed is very soft. It was made for safely riding in a soft vein, not a rigid and muscular chest wall. They often just collapse once the stylus is withdrawn, rendering the elaborate rigging of one-way valve systems afterwards rather pointless. The Turkell has a catheter engineered for the purpose, with a built in placement indicator. It's an elegant part of the optimal solution in my opinion.

The definition of Bougie: “A thin cylinder of rubber, plastic, metal or another material that a physician inserts into or though a body passageway, such as the esophagus, to diagnose or treat a condition. A bougie may be used to widen a passageway, guide another instrument into a passageway, or dislodge an object.” One of the most common uses of the term in medicine refers to a weighted esophageal dilator. Introducer is probably a more accurate description. You put the narrow bougie (introducer) in first when confronted with a difficult intubation, and then send the ET tube down over the long stylet. An even better technique is to pre-load the introducer in the ET tube, holding them together in your right hand. That way you are not fumbling when trying to hold the introducer while feeding the tube down over the top. Another name this type device can go by is ET Tube Changer. RT's have been using these for years to permit changing an old tube, or one with a bad cuff for a new one, without needing to perform laryngoscopy. You just slide down the "changer", and pull out the old tube while leaving the changer in position. Then you slide the new one on to the previously noted depth. But the length and diameter of these tube changers and introducer's and bougies are all nearly the same. So by whatever name, for our practical purposes in EMS they remain the same. The first time I saw one about ten years ago, it was in the back pocket of an anesthesiologist at Shock Trauma in Baltimore. When I asked what it was he explained it and shared that he had not performed a surgical airway since starting to use it. That really got my attention, and after trying it once I was hooked. The nice thing about this device is the ease of learning & skill retention. The problem with many alternate airway techniques is that they are very different from your normal intubation technique.With a bougie, you are still using the same basic technique as normal. Scope in left hand, tube in right, passed under direct visualization. That makes it easier to learn and retain the skill, even when used infrequently.There are several different bougies available. My favorites are the #JEM370 from Instrumentation Industries, and the SunMed #9-0212-70. Either is stiff enough to enhance control. One of the two available SunMed models has a “bent” or coude tip, which allows you to feel the movement of the stylet tip against the tracheal rings during insertion. This is the least expensive alternate or backup airway adjunct on the market. It can help you secure a definitive airway under the toughest field conditions. These devices are less than 10 bucks each. Bang for the buck wise, this is a great value for what it can do in a pinch.

No you are not. Congratulations, you are practically the very first to figure this out on their own! High FIO2 w PEEP is not CPAP, but it helps the same patients better than a NRBM. Of course no inspiratory pressure support means you really can't call this thing CPAP. It's helpful, but does not do Continuous, or Constant (both Inspiration & Expiration) Positive Pressure. The single most popular reason to use it - is when an agency has a whole lot of different ED's they go to. Then the ability to just put them on ED wall flowmeter and leave is appealing to many. It is in my opinion, better than the Boussignac disposable which only does low FIO2 w PEEP. No reservoir, no inspiratory flow support. I have a decent ppt on Oxy-Peep if you want, e-mail phillydan@hotmail.com