FDNY EMTs do not let Private Medics help with choking child

[spenac]

The kid was 4, a large bore needle for the 10 minute ride would have been more than adequate. Attempting an open surgical cric on a 4 year old would have been a waste of time in my opinion.

I'll have to disagree. A needle will not even began to provide adequate oxygen. It should only be a temporary solution while you prepare cric kit.

Here is a good article that describes various methods.

http://www.touchbriefings.com/pdf/2444/fildes.pdf

Article says not on children but in life threatening situation airway is first. Remember life over limb rule of EMS.

[spenac]

As spenac mentioned. At the very least it would seem you would need two needles if you wanted any chance of avoiding the creation of a pneumo in this situation, yet I'm having a difficult time seeing where even a 10g would do much good.

Perhaps I just don't understand the psychics involved...

Dwayne

Dwayne in my Intermediate education I was taught that you place two 14g or larger catheters. Bag with high flow O2 on one the other will prevent pneumo tension. Amazingly often you do not have to bag as patient trys to breath on own normally after needle placement. This is only a temporary procedure while preparing cric kit. In 5 minutes time patient will be extremely oxygen deprived. There are many easy to use cric kits that limit the risk. They are expensive though and many services choose to just have us use a scalpel and regular ET tube.

[Apokryphos]

So they basically get detention for aiding in the death of a small child, but not following protocols, and regulations. Oh that's gonna teach them. Great thing to do, slap them on the hand.

That's pretty pathethic, a license supension is needed, and yet another trip through the EMT-Basic course.

[p3medic]

1. Pediatric age group—due to difficulty with smaller

patients cricothyroidotomy should not be

undertaken in children under ten unless absolutely

necessary, and should not be undertaken at all in

children under five. In this latter age group,

emergent tracheostomy, orotracheal intubation with

in-line cervical stabilization (even if cervical spine

injury is suspected), or needle cricothyroidotomy

may be preferred.

Spenac, this is a direct quote from the article you sited. In this 4 yo child, the best course of action would have been a large bore needle, 14-10g. You can ventilate adequately longer than you think through that.

Dwayne, if the obstruction is at the glottis then a needle placed through the cricothyroid membrane would be below the obstruction, allowing for oxygenation as the ball be obstructing most airflow above. Ventilation would take a bit longer, and the rate would need to be low to allow time for passive exhalation. CO2 would rise, however the body can do just fine for a long time with hypercapnia, not so much with hypoxia.

[DwayneEMTP]

Dwayne, if the obstruction is at the glottis then a needle placed through the cricothyroid membrane would be below the obstruction, allowing for oxygenation as the ball be obstructing most airflow above. Ventilation would take a bit longer, and the rate would need to be low to allow time for passive exhalation. CO2 would rise, however the body can do just fine for a long time with hypercapnia, not so much with hypoxia.

Thanks for the explanation. I understand the concept, but I'm still unclear on exhalation. Assuming that the ball created a complete obstruction, to exhalation as well as inhalation, then I have a hard time seeing enough exhalation to created adequate ventilation.

I'm not at all doubting your accuracy, as the needle cric is taught, and seems to be in most protocols. It's just, as we have the ability to ventilate with higher pressure into the needle, creating enough pressure to overcome the size of the lumen, but I'm having a hard time imagining enough passive pressure through that size lumen to adequately exhast the CO2 rich lung contents. See what I mean?

No problem getting O2 in, because we can pressurize that, but lots of trouble getting it out it would seem.

Just a thought...

Dwayne

[Mateo_1387]

Dwayne, that is a great point. That is why I think the needle cric is not worth much. I guess you would have to push on their chest to put some pressure on the chest allowing the air to slooowwwlllyyy escape through the lumen of the catheter. Not worth much in my opinion.

[Dustdevil]

So they basically get detention for aiding in the death of a small child, but not following protocols, and regulations. Oh that's gonna teach them. Great thing to do, slap them on the hand.

That's pretty pathethic...

Welcome to the land of unions.

[FormerEMSLT297]

Welcome to the land of unions.

I think that the question that needs to be answered is ,,,, Did they do this intentionally as some of you belive, or was this just a mistake as others have suggested?

I mean did they hear the medics on the radio and still pull off, or did they mistake the banging on the door (let me in) for the take off to the hospital.

If it was intentional BURN them,, there is no excuse. If it was a mistake, then they deserve a second chance. Retraining and education is part of the QA/QAI process, which is confidential. In addition to the retraining, no one on this board knows what will happen to them administratively. They may in fact when all is said and done get suspended, written up whatever...

[medic8]

Oh please, we all know what the outcome will be. So those guys better be prepared.

[Dustdevil]

Oh please, we all know what the outcome will be. So those guys better be prepared.

For what, a promotion, or just a raise?