Combitube placement

[brentoli]

Combitubes.

At what point will an ALS provider pull one that was established by a BLS provider?

Do you take out every one you come up on? If it is an established airway, do you keep it in?

I have seen medics on both sides. We have one that is infamous for pulling the tube as soon as he walks up to the paitent, with out even listening to breath sounds. We have another, who will leave it in place all the way to the hospital as long as it remains in place.

[Grumpy]

They are not used in my service we have LMA's as a back up for a failed RSI ( haven't used one yet). I would not want to remove any patent airway that is working. Why tempt fate.

[spenac]

I leave the combi. Just confirm bagging right tube.

[medicmissy]

I never pull the tube. I have pulled one once because the cuffs failed and we had no choice.

If the emt puts the tube in, I now have the chance to move on to iv and meds. I appreciate our emts and it all has to do with workin as a team and just gettin it all done so we can move on to the next call.

[Dustdevil]

At what point will an ALS provider pull one that was established by a BLS provider?

Contradiction of terms.

Invasive airway procedures are ALS procedures. If you perform an ALS procedure, you are providing ALS.

Any provider who inserts a Combitube is, therefore, an ALS provider.

Perhaps you meant, "At what point will a Paramedic pull one that was established by an EMT-B"?

[brentoli]

Just answer the question Dust. 8)

[Dustdevil]

Whether a patient has a Combitube down or not, a medic's first step is the same. You assess the patency of the airway and the effectiveness of ventilations. If those are good, you're good. If they're not, then it's coming out. But it's not coming out just because I am pissed off because I got screwed out of an intubation, or because I have a chip on my shoulder about first aiders practising way over their heads. It's coming out because the patient's life depends on it. The best interests of my patient are my only concern at this point.

Now, of course, the patency of a Combitube do not preclude me from still intubating the trachea, and I will most likely do that also. The Combitube is not (usually) a definitive airway, and since it's now my arse on the line for the patient's proper care, it is incumbent upon me to provide a definitive airway, regardless of what the EMTs did.

So the question is, are you painting an accurate picture? Are they yanking all these tubes because they're arseholes who don't like EMTs? Or are they replacing a rescue airway device with a definitive airway because it is best for the patient? There is a difference.

[RedKnight]

I'll put in my vote with the old Farmer's Adage:

"If it ain't broke don't fix it."

[brentoli]

Thank you for the answer, Dust.

The one medic that has a reputation for doing it, seems to not care.

He doesn't check for patency. It just comes right out. It has bit him in the ass one time, but that wouldn't have been a save anyway. I don't have a problem with my tube being pulled. I don't take exception to it. I was just curious if it is a standard practice.

[Dustdevil]

I was just curious if it is a standard practice.

Common? Probably so. But standard? Definitely not.

Hell, out here the EMT-Bs put in chest tubes and tracheotomies before I get the patient, and I don't go pulling those out. Discontinuing any intervention without first assessing the need for its continuation, as well as its effectiveness, is just bad medicine. Those same guys would probably DC a tourniquet just because it was there. Sounds like somebody is due an immediate attitude adjustment and some serious education. Or unemployment. Either way, I'm okay with that.