airway management vs spinal precautions

[MAMed]

I was reading an article on Jems.com today about how the concerns of post mechanism spinal insult inhibits the ability to place an advanced airway which results in hypoxia and/or improper treatment of a TBI from same said mechanism. The article goes on to state that the slight (relative term) spinal manipulation involved in direct laryngoscopy will not usually result in any injury that did not occur in the initial mechanism.

I have a thinking out of the box question so please tell me what you think.

Rather than direct laryngoscopy, put a OPA in each corner of the jaw as a bite block and do a digital intubation. This will minimize mandibular displacement.

[chbare]

Well...I guess you could try the technique. However, what kind of success rates are we talking about? If you need an airway, you can assume a few things. First, you have a crash airway that is most likely traumatized or full of crap. Second, you have RSI'd your patient and the point of RSI is to assist with first time success rates. Finally, you have chosen to go with nasal intubation.

In patients with suspected head and neck injuries I will release the c-collar, have somebody hold manual in line spinal immobilization, and intubate very carefully taking into consideration the patients injuries. A bougie will also be of great benefit if you are having a hard time obtaining a good view in these patients.

Take care,

chbare.

[akroeze]

Lighted stylet would be a good choice

[AZCEP]

Have someone else hold manual in-line position, and remember that you are only trying to move the tongue out of the way. If you are lifting the head off the table, you are working too hard.

A lighted stylette is a great idea, if not very common. The bougie will also make things much easier. Nasal intubation is not very useful in the crash airway situation.

What will kill the patient first? Lack of an airway, or a secondary SCI?

[chbare]

I was only using the nasal as an example of one of the pathways people consider. I typically see three things: we choose to rsi, not sure about rsi so we go nasal, or the crash airway.

Take care,

chbare.

[MAMed]

I appreciate it. I was an idea that ran through my mind because I had to do a digital the other day on a code when the batteries died on the blade while I was attempting to tube. By the way, state health dept. won't give us "ambulance drivers" RSI and I don't have access to lighted stylets. Like I said, just an idea. Thanks

[AZCEP]

I was only using the nasal as an example of one of the pathways people consider. I typically see three things: we choose to rsi, not sure about rsi so we go nasal, or the crash airway.

Unfortunately, too many don't consider nasal intubation at all. RSI has killed it off in those places that have been so blessed. I've rescued myself with a nasal tube several times when an oral attempt went bad.

We don't have RSI available until an aircraft arrives, unless you count the home version. :wink:

[chbare]

Good point. It is a good option when somebody needs an airway but rsi would be very diffiult. A no neck 300 pound patient for example.

Take care,

chbare.

[northernmedic]

Whenever I am getting set up for a trauma intubation I always have my partner get the bougie ready. In my opinion it is the cheapest but most useful addition you can make to your airway kit. I have intubated several very soiled/bloody airways basically by feel using a bougie when bleeding is so severe it cannot be totally suctioned clear.

[Medic26]

Unfortunately, too many don't consider nasal intubation at all. RSI has killed it off in those places that have been so blessed. I've rescued myself with a nasal tube several times when an oral attempt went bad.

I think this exactlty why RSI has been abused in the prehospital setting. Medics are so afraid of a little bit of blood in the nasal passage to attempt Nasal tubes. Since CPAP has been introduced our nasal tubes have declined in frequency but I still consider it on any patient that I want to secure an airway on, and they are actually fairly simple.