okmedic Posted November 27, 2008 Share Posted November 27, 2008 Personally if I cannot ventilate because of a FBOA, and am unable to remove it I will more than likely be getting out a scalpel and a 6.0 tube. Link to comment Share on other sites More sharing options...
defib_wizard Posted November 27, 2008 Share Posted November 27, 2008 I agree with you on performing the surgical cric. However some of the people posting and I believe the OP are BLS level. They can't go after it or cut the pt. Link to comment Share on other sites More sharing options...
WolfmanHarris Posted November 27, 2008 Share Posted November 27, 2008 What are you talking about? I've seen it on tv like five six times. Bic pen, pocket knife. Father Mulchaey used an eye dropper. Looks easy. :wink: Link to comment Share on other sites More sharing options...
Pipey Posted November 27, 2008 Author Share Posted November 27, 2008 As the original poster -- BLS -- and CPR instructor -- I appreciate all the observations, comments, insights. I learned quite bit and I'm happy the question was treated the way I hoped it would be. I had not come across the argument for getting the blockage deeper into a bronchi to get an airway and worrying about infection later. Also interested in the compressions with NRB only. I was aware of the residual O2 and using compressions as another way to drive intrathoracic pressure. Surgical cric not an option for me but I remember the BIC pen deal. I was recently asked the question I posed here and didn't think I had a good answer. I do now. Many thanks. Happy to hear any other observations. Link to comment Share on other sites More sharing options...
mobey Posted November 27, 2008 Share Posted November 27, 2008 C-spine is important, but lack of oxygenation is more important, so you do not spend 10 minutes applying a ccollar and KED. Yes, they may have a cspine fracture, but that doesnt matter if they die. I have 2 problems with this statement Problem #1 - KED is NOT for rapid extrication. Problem #2 - If they have a C-Spine fx and you manipulate it it does not matter if you bring them back because they will never get off the ventilator. Put the patient on a LSB with head immobilised and work the code. Again I will say - Spinal Immobilization is NOT life over limb..... It is life over death. Link to comment Share on other sites More sharing options...
WolfmanHarris Posted November 27, 2008 Share Posted November 27, 2008 I agree Mobey. I feel like that is the sort of thing I'm used to hearing/teaching in first aid and first responder courses as the worst case scenario. But professional providers should be able to balance basic C-spine immobilization around their resuscitation in most cases. In fact I ran a scenario with just this issue today in lab. It was a bit of a juggle to be running the algorithm and getting the collar and board on and strapped but we got it figured out. Yes on the balance sheet ABC's over c-spine any day, but that doesn't mean you forget c-spine entirely. Link to comment Share on other sites More sharing options...
firedoc5 Posted November 28, 2008 Share Posted November 28, 2008 I agree Mobey. I feel like that is the sort of thing I'm used to hearing/teaching in first aid and first responder courses as the worst case scenario. But professional providers should be able to balance basic C-spine immobilization around their resuscitation in most cases. In fact I ran a scenario with just this issue today in lab. It was a bit of a juggle to be running the algorithm and getting the collar and board on and strapped but we got it figured out. Yes on the balance sheet ABC's over c-spine any day, but that doesn't mean you forget c-spine entirely. Back when ITLS was known as BTLS, you were taught to be able to "in-line" intubate, which I'm sure is still being taught. I was in second class taught in the state at the time, so not everyone was familiar with it. I really made a more senior Medic mad when he didn't want tube someone due to not wanting to compromise c-spine. So I asked if I could show him something. At least I asked. But after we got to the hosp. he started to lay into me. The doc and one of the nurses were over hearing this and took my side. I don't think that Medic talked to me for a month. But that was no snot off my nose. Link to comment Share on other sites More sharing options...
celticcare Posted April 9, 2009 Share Posted April 9, 2009 Hahaha you're always going to get them Doc, and as you say, no snot of your nose. OP - Compressions and FBAO, its been said in the posts above me and so I wont repeat it on the reasoning of Compressions. Here in New Zealand we do chest compressions for that mere fact of increased interthoracic pressure to give a chance of POP *it coming out, not a lung lol*. Intermediates here can do direct laryngascopy and mcgills forceps to remove the object if seen. The side issue raised on C-Spine management, the statement about "they'll never come off the ventilator", couldn't agree more, nursed a guy in ICU with that exact same issue, people pulled him out and started CPR, yeap he lived but with the rough movement *as reviewed by the doctors* an already injured spinal cord snapped at c5. Bye bye phrenic nerve and that patient never left the ventilator. No Oxygen = no brain = bye bye blue sky No Breathing ability = no oxygen = no brain = bye bye blue sky. C-spine care is important as airway care. Link to comment Share on other sites More sharing options...
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