Intubation FAIL

[Spock]

Look what you started Dust! You da man!

Live long and prosper.

Spock

[Dustdevil]

Look what you started Dust! You da man!

[HERBIE1]

20 years and you seem to have no respect for nurses and MDs? That must have been a rough 20 years for you and those that had to work with you. The one thing that working in a hospital has taught me is teamwork with many different professionals as well as respect for their abilities and education. If you see yourself as being constantly criticized by RNs and MDs, then maybe you have some security issues of your own or you are giving them a reason to criticize you. I do realize that some who have the lesser certs and lesser education do feel "picked on" but you must realize those with the higher credentials and education are not the ones holding you back. When you stop blaming others, you can move forward.

More strawmen. Never once did I say, imply, or insinuate that I had no respect for RN's or MD's- I simply stated a fact. I always knew my role in a hospital setting, and did it to the best of my ability. As a result, I was able to earn the trust and respect of my coworkers and take part in many procedures and situations normally reserved for more highly trained providers. I have done open cardiac massage, inserted chest tubes and central lines. I was like a sponge-I couldn't stop learning, loved every minute of my time with those people, and am forever grateful for their patience and assistance.

Who started the name calling? Were my posts intimidating to you? Bullying you? Gee whiz...

Move on and stop blaming nurses and doctors for any shortcomings you have or for the shape of EMS around you.

One of my major shortcomings is a lack of tolerance for people who have inflated opinions of themselves and the depth and breadth of their knowledge. I would also never presume to lecture you about your area of expertise.

Sorry bud-it takes much more than you have to intimidate or bully me.

[VentMedic]

Sorry bud-it takes much more than you have to intimidate or bully me.

LOL! It seems like you've tried very hard to convince me of that which usually means a nerve has been struck.

I have done open cardiac massage, inserted chest tubes and central lines.

It seems like you still focus on "skills". Paramedics did chest tubes and central lines for years but found there was little need on most ground EMS trucks to hang on to these skills. Yes, we can still do them on Specialty and Flight but that doesn't mean we will or, in most cases, should. Knowing when to do them and when not to do them is just as important as the actual hole poking skill.

Open cardiac massage is just like CPR. Whoever is around gets to do the deed. If you are working in a Trauma unit, CCU or ICU, that is a "skill" one should be familar with.

LOL. Did I forget the sarcastic smiley? Sorry about that.

spenac, I seriously miss your sarcatic debates. You just had to turn into a gentleman and an almost perfect one at that.

[spenac]

spenac, I seriously miss your sarcatic debates. You just had to turn into a gentleman and an almost perfect one at that.

LOL. I'll try harder, just thought you needed a break.

So what do you think of the LEMON assessment prior to attempting intubation?

[Kiwiology]

I think EMS needs to pull its head out of its arse. We take away, add or change procedures, practices and processes because they are of benefit to the patient (or not -- as the case may be).

In my lifetime we've gone from shocking the heck out of people and pumping thier coded ass full of lidocaine, bretylium, atropine, adrenaline and sodium bicarb to lots of CPR and maybe a shock every second cycle and using only adrenaline and amiodarone. We no longer use the MAST pants for autotransfusion in hypovolemic trauma patients, nor do we run fluids wide open through two 14gu. IVs. Gone are the days of giving naloxone and 50% dextrose to every guy we find down and out on the sidewalk.

All these things have changed because they have found to be in the best interest of the patient, remember, that person who we are treating and supposed to be helping?

While the numbers may or may not be shady given the research methods of this one particular paper; if intubation is not found to be in the best interest of the patient then we shouldn't continue doing it! Bledsoe had it right when he said too many people are in EMS because it's "fun" .... well not intubating people may not be "fun" but if that's your perspective get the hell away from me!

[tniuqs]

'kiwimedic'

I think EMS needs to pull its head out of its arse. We take away, add or change procedures, practices and processes because they are of benefit to the patient (or not -- as the case may be).

When one actually looks at the take away or add "whatever" this is controlled by the MD in most cases ... not the Medics at all, once again equating outcomes "to door" is huge folly, dependent on one procedure ONLY, its just bad science with the vast amount of variables.

<Snip>

All these things have changed because they have found to be in the best interest of the patient, remember, that person who we are treating and supposed to be helping?

CONCLUSION: This prospective study showed a 31% incidence of failed PHI in a large metropolitan trauma center.

Do the Math so 69 % of prehospital Truama ETI gave the patient the best chance of survival, no brainer really, no heads out of rectums needed and survival to door as I have said over and over this NOT the litmus paper we need to dictate what we do in field ... Trauma patients die from Trauma and other than large metropolitan trauma center. I can not BVM for hours while moving in Helo, Fixed wing or in the back country on rough dirt road seriously I need a ET in to ventilate properly or my patients will die and try putting a ventilator attached to an LMA or Combi Tube in these conditions.

And whatever Ventmedic not taking the bait about Flight RNs and lack of QA in Canukistan University of Alberta Hospital history (Banting and Best = Insulin) (Curing HEP C)( Transplantation of cells from islet of Langerhans and no dependence on Insulin) (Stollery Children's hospital world recognized for Peads Cardiac Surgery) nice try though.

Some good ideas with P. Brindly addressing the issue of failed attempts with "win with the chin" concept concentrating on the issue of improved educational practice, I though it was a positive note to address the subject. Oh well, cant say I didn't try.

We found no difference in mortality between patients who were properly intubated and those who were not, supporting the use of bag-valve-mask as an adequate method of airway management for critically ill trauma patients in whom intubation cannot be achieved

promptly in the prehospital setting.

Again key word "promptly" WTF is defined as promptly one has to call BS when one sees it.

While the numbers may or may not be shady given the research methods of this one particular paper; if intubation is not found to be in the best interest of the patient then we shouldn't continue doing it! Bledsoe had it right when he said too many people are in EMS because it's "fun" .... well not intubating people may not be "fun" but if that's your perspective get the hell away from me!

For those that think its FUN to put a tube in any oriface the need to go the way of the Dodo, I think its a "successful call" when I can use less invasive means to stabilise a patient, and even considering RSI or ETI is a risk vs benefit ratio anything else and get off my truck ... wacko, go become a coroners helper ... then you get to cut dead people up too ...

cheers

Edited August 6, 2009 by tniuqs

[VentMedic]

When one actually looks at the take away or add "whatever" this is controlled by the MD in most cases ... not the Medics at all, once

Do the Math so 69 % of prehospital Truama ETI gave the patient the best chance of survival, no brainer really, no heads out of rectums needed and survival to door as I have said over and over this NOT the litmus paper we need to dictate what we do in field ... Trauma patients die from Trauma and other than large metropolitan trauma center.

Read the full study.

Also, remember it was the Canadians who studied trauma patients in OPALS.

And whatever Ventmedic not taking the bait about Flight RNs and lack of QA in Canukistan University of Alberta Hospital history (Banting and Best = Insulin) (Curing HEP C)( Transplantation of cells from islet of Langerhans and no dependence on Insulin) (Stollery Children's hospital world recognized for Peads Cardiac Surgery) nice try though.

I known nothing about this hospital and their Flight RNs. However if you say the Canadian nurses are crap then maybe they need to look closer at improving. I can only speak for the Flight programs here in the U.S. and RNs I am aware of and they are definitely not idiots when it comes to providing quality medicine.

[tniuqs]

Also, remember it was the Canadians who studied trauma patients in OPALS.

As to why the OPALS study is flawed...

Although it claims to have been a before and after study that noted the changes in patient outcome with ALS, its before data is skewed as to its numbers. Were these same numbers gathered from the 17 OPALS communities before the ALS medics were trained and sent out to practice in the community? NO, the 17 base hospitals were not collecting such data before 1994.

Lets compare apples to apples. What is the survival rate of cardiac arrests that enter the ER and take place in the ER in these same communities when the study question asks the benefit of ALS in the field? There was not a study in this area that gathers the ER data, thus would any improvement in the ALS save rate not be beneficial? No data that compares this.

There was an improvement in save rate from 3.9% to 5.2% with in-the-field rapid defibrillation, but only an improvement of 5.0% to 5.1% with ALS treatment. Hmmm... compared to what? Give me relevant data to compare it with. And was there a bias in the researchers focus towards supporting CPR, rapid defibrillation, or relating such data to physicians in the ER (see note A below)? Objectively speaking, all data in trying to raise the dead is poor so why compare ALS medics to God when the stats are not available for the docs in the ER where the save rate would be questionably worse.

All the reported OPALS data to date is geared to rate objective information. This is better than subjective study analysis in its validity, but is there a study that can rate how well a psychiatrist works with their patients? No, its all subjective unless one counts how many people out of the total actually commit suicide, bodily harm, or other crimes with the therapy of a psychiatrist verses without one. Has OPALS researched the subjective outcomes of patients who improve in their ischemic chest pain, improve in their state of respiratory distress from asthma or chf, improve in their state of hypoglycemic coma, improve from their narcotic induced coma, or improved in their state of oxygenation from hypoxia or an occluded airway? No! How does a drug company know that their NSAID is affective with arthritis pain? They ask the patients. Has an ALS medic ever performed an act that has improved the patients short or long term outcome? How would the outcome have changed if ALS was not available? As patients were not questioned, such relevant supporting data is not available.

In response to note A - No improvement in the dead patients with ALS translates into what? And when compared to what? The investigator gives the notion to its readers in the conclusion that ALS bares no assistance in VSA patients so spend your tax dollars elsewhere. Hmmm... why didn't the investigator submit the results on chest pain, diabetic emergencies, or shortness of breath before the results that were obviously going to appear poor before the eyes of the public and its financial caretakers?

Lastly, does the question of the study results translate into a taxpayer's bag for their buck in any way or fashion? A tax payer is always more worried about who is going to pick up their garbage on Tuesday morning verses the training of paramedics that pick them up, as nobody anticipates that need for an ambulance. But, ask those after the fact of receiving such care and the improvement that incurred during such care and they will be the ones to say more ALS medics.

Note A - Conclusion statement of cardiac arrest study "There was no improvement in the rate of survival with the use of advanced life support in any subgroup. The addition of advanced-life-support interventions did not improve the rate of survival after out-of-hospital cardiac arrest in a previously optimized emergency-medical-services system of rapid defibrillation. In order to save lives, health care planners should make cardiopulmonary resuscitation by citizens and rapid-defibrillation responses a priority for the resources of emergency-medical-services systems."

Cheers

[medic82942003]

Our State is trying to improve intubation results, everyone IE Medics must perform at least

12 tubes a year. I work for a private EMS, but the problem I see in the City is alot of medics

are getting lazy, one shot at the tube- then here comes the combi tube. I saw a truamatic arrest

come in the other night. Motercycle 70 MPH hit a cement wall. The medics stuck a OPA in bagged

him, did half ass CPR going in to the code room. No BB straps No C collar. needless to say the Docs

went apeshit when they brought him in BLS on a ALS rig. I foresee licensure getting yanked or suspeneded. But if you cant stand the heat-time to leave the kitchen./or burning building if your a fireman. be safe cheers.