spenac Posted July 3, 2007 Share Posted July 3, 2007 To attain a good seal also keep in mind you can shave area so allows better seal. A little time consuming but if you have a long transport worth it if you can only provide BLS air support. Patient if they ever wake up may not like it but your talking life over hair. The gell seems like it dissappears after a while, so if go that route remember to re lube. Link to comment Share on other sites More sharing options...
Ridryder 911 Posted July 3, 2007 Share Posted July 3, 2007 I would had RSI as well, (traumatic patients needs a patent airway) and intubated if not able to intubate then alternative airway such as a Combitube..etc. If not able to perform this then surgical airway.. really no biggy. A Paramedic should be comfortable in performing these skills they are part of the job. As well, I do NOT recommend needle crich's as they are almost as harmful than helpful with retaining of C[sub:cabf2ce5ba]O[/sub:cabf2ce5ba]2 level and inability to ensure V[sub:cabf2ce5ba]t[/sub:cabf2ce5ba]. Yes, if and after the airway is managed I would attempted to obtain a XII lead, but most of the diagnostics I have seen and used for identifying a tamponade has been through physical assessment and MOI hx. Bruising over the pericardial area, and yes even decreased muffled heart tones can be obtained. We carry dopplers on each truck and they do assist in the ambient noise. Again, common sense should be used and really how long and difficult would a XII lead be able to obtain? As additional reasons for RSI is to < and maintain ICP, as it is essential to maintain the SPC[sub:cabf2ce5ba]O[/sub:cabf2ce5ba]2 < 30mm/hg. R/r 911 Link to comment Share on other sites More sharing options...
spenac Posted July 3, 2007 Share Posted July 3, 2007 I got to agree with rid. Get a good airway established. It's just a matter of time before it's no longer patent. If it is no longer patent a needle cric will allow your partner to move a little air into the patient while you prepare for the cric. A suggestion is to place 2 needles for the needle cric, one with a flutter valve like in chest decomp. A needle cric should be in use no more than 5 minutes and replaced with a tube during surgical cric. But that all can be avoided by early ET tube placement in the trauma patient. If as stated is a difficult tube use your partner, cricoid pressure or for a sky hook. Several ways to get a good look at your landmarks. Don't stay and play this guy needs a good trauma team yesterday to make it. Link to comment Share on other sites More sharing options...
chbare Posted July 3, 2007 Author Share Posted July 3, 2007 Upon arrival at the trauma center, the ER physician attempts to perform a cric and obtain a surgical airway without success. Surgery is called and they end up having to perform a trach to establish a definitive airway. FAST exam is + for intra-abdominal blood. The patient is taken to OR where both liver and spleen injuries are identified and repaired. In addition, a Leforte II fracture is identified along with a cerebral contusion and basilar skull fracture. No additional follow up information is available. On a side note: I suspect the high airway pressures and high ETCO2's were likely related to the fact that this patient was very large and required higher airway pressures for adequate ventilation. Many of the rescue devices will leak around the 20-30 mm/hg mark, and I suspect that the patient was receiving a less than optimal Vt and this led to retained CO2. I hope everybody enjoyed this scenario. This is a little different than my "usual" scenario, but we cannot always live in the land of Oz. Sometimes it is nice to see how people think when confronted with the same problem, hence, the title "out of the box." Take care, chbare. Link to comment Share on other sites More sharing options...
spenac Posted July 3, 2007 Share Posted July 3, 2007 Upon arrival at the trauma center, the ER physician attempts to perform a cric and obtain a surgical airway without success. Surgery is called and they end up having to perform a trach to establish a definitive airway. FAST exam is + for intra-abdominal blood. The patient is taken to OR where both liver and spleen injuries are identified and repaired. In addition, a Leforte II fracture is identified along with a cerebral contusion and basilar skull fracture. No additional follow up information is available. On a side note: I suspect the high airway pressures and high ETCO2's were likely related to the fact that this patient was very large and required higher airway pressures for adequate ventilation. Many of the rescue devices will leak around the 20-30 mm/hg mark, and I suspect that the patient was receiving a less than optimal Vt and this led to retained CO2. I hope everybody enjoyed this scenario. This is a little different than my "usual" scenario, but we cannot always live in the land of Oz. Sometimes it is nice to see how people think when confronted with the same problem, hence, the title "out of the box." Take care, chbare. Whats wrong with the doc, me and rid had successfull crics. Good scenario thanks. Link to comment Share on other sites More sharing options...
ERDoc Posted July 3, 2007 Share Posted July 3, 2007 Whats wrong with the doc, me and rid had successfull crics. Good scenario thanks. Apparently no one is listening to me. The ER doc didn't use a pen and pocket knife! That is the secret to a successful cric!!! Link to comment Share on other sites More sharing options...
spenac Posted July 3, 2007 Share Posted July 3, 2007 Apparently no one is listening to me. The ER doc didn't use a pen and pocket knife! That is the secret to a successful cric!!! I'm sorry. You know actually saw wilderness survival video that showed surgical cric using keys and a pen. Ouch. But the point was they're dead if you do nothing. Link to comment Share on other sites More sharing options...
p3medic Posted July 5, 2007 Share Posted July 5, 2007 Upon arrival at the trauma center' date=' the ER physician attempts to perform a cric and obtain a surgical airway without success. Surgery is called and they end up having to perform a trach to establish a definitive airway.quote'] Ridryder 911 Posted: Tue Jul 03, 2007 4:01 pm Post subject: -------------------------------------------------------------------------------- I would had RSI as well, (traumatic patients needs a patent airway) and intubated if not able to intubate then alternative airway such as a Combitube..etc. If not able to perform this then surgical airway.. really no biggy. A Paramedic should be comfortable in performing these skills they are part of the job. Every patient needs a patent airway, this one is no different, however the "how" we provide it is up to debate. If BLS maneuvers isn't feasible, which I certainly can believe, sedation and attempt at intubation may be a safer route than RSI. Sounds like surgical airway was a "biggy", this guy doesn't sound like the type of patient you want to have to cut. Good case. Link to comment Share on other sites More sharing options...
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