List Archives

Sat, 23 Nov 2002 17:44:06 -0000

I find it interesting that people are still recommending intervening,
and risking catastrophe by intubation or even worse cutting into the
neck! Think through the consequences of this. Intubation. Whatever the
genesis of the swelling you are at risk of subglottic swelling occluding
beyond the reach of the tube. The whispering is laryngeal damage, and
probably to the recurrent laryngeal nerve. It is a triviality. At
present, he does not have risk to airflow through the lower airway as
that would present with stridor. Cricothyroidotomy (or even worse, as
someone suggested, elective field tracheostomy) may enter a haematoma,
and this (as was later discovered) may very well be arterial. Crazy to
intervene in either, and completely indefensible if it goes wrong.
However, if he loses the airway you are in a different situation
entirely and must attempt to restore patency. By this time, you will be
that much nearer help, and your equipment will be out and ready. You
also will have a good idea why he has obstructed. Stop the ambulance,
take your time and intervene appropriately. Yes, you may lose him, but
my risk analysis is that you are taking a much greater risk by
intervening earlier than that. Your final sentence is that two attempts
failed. Disaster upon calamity. Well, what happened?

R

-----Original Message-----
From: trauma-list-admin@trauma.org [mailto:trauma-list-admin@trauma.org]
On Behalf Of Reuven Dichter
Sent: 23 November 2002 16:17
To: trauma-list@trauma.org
Subject: Re: Difficult airway

Hello guys,
In any patient with impending Airway obstruction we should protect the
Airway as much as we can. This includes Intubation, LMA or Cric. Eitan
has described 2 major facts that should lead you to the only decision
here: The patient is whispering and the 45-min. too trauma center. No
doubt here: Go immediately for Surgical Cricothyrodotomy. One can not
take a patient with a penetrating neck injury & significant edema
without securing his airway.

Reuven Dichter - EMTP BA
Head instructor
The Israeli Paramedics Academy - MDA

972-53-696418

----- Original Message -----
From: "Eitan Melamed" <eitanme2000@yahoo.com>
To: <trauma-list@trauma.org>
Sent: Saturday, November 23, 2002 1:15 PM
Subject: RE: Difficult airway

> The scene was 45 minutes from a trauma center(and from
> any other hospital), indeed with poor conditions for intubation. The 
> available drug was ketamine.
> --- "Bjorn, Pret" <pbjorn@emh.org> wrote:
> > I think this depends on where (and under what
> > conditions) this initial
> > intubation attempt is being made.  If you're
> > monkeying with a partially
> > obstructed airway at the scene, then I agree that
> > you're making a mistake.
> >
> > If, on the other hand, this patient is being treated
> > at a local community
> > hospital in preparation for an hour's drive to the
> > trauma center, I think
> > there's a very strong argument for intubating in
> > good light on a level
> > surface with ample equipment, supplies, drugs and personnel.  It's 
> > immensely easier to intubate a partial obstruction in a small
> > ED than a complete
> > obstruction in the back of a large truck.
> >
> > Not clear which scenario is in play here.
> >
> > Pret Bjorn
> > Trauma Coordinator
> > EMMC Trauma Program
> > 489 State Street
> > Bangor, ME 04401
> >
> > 207.973.7260 (office)
> > 207.973.7673 (fax)
> > 207.941.5085 (voice pager)
> >
> >
> > -----Original Message-----
> > From: P. Hoffman [mailto:phoffman@freeway.net]
> > Sent: Friday, November 22, 2002 10:47 AM
> > To: trauma-list@trauma.org
> > Subject: RE: Difficult airway
> >
> >
> > I, too, am curious...  Why the intubation?  Is there
> > more to the story than
> > you reported?
> >
> > Phil Hoffman
> > EMTP
> >
> > -----Original Message-----
> > From: trauma-list-admin@trauma.org 
> > [mailto:trauma-list-admin@trauma.org]On Behalf Of Eitan Melamed
> > Sent: Friday, November 22, 2002 9:28 AM
> > To: trauma-list@trauma.org
> > Subject: Difficult airway
> >
> >
> >
> >
> >  Here's a case from a of week back.
> >
> > A 20 year old gets a penetrating missile neck wound, develops 
> > swelling in his neck. He talks with a whispering voice, Sat%-98, GCS

> > 15 at scene. Before taking him to a trauma center, which is 45 
> > minutes away, intubation is attempted. 2 attempts fail.
> > What next?
> >
> > __________________________________________________
> > Do you Yahoo!?
> > Yahoo! Mail Plus - Powerful. Affordable. Sign up
> > now.
> > http://mailplus.yahoo.com
> >
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit: 
> > http://www.trauma.org/traumalist.html
> >
> >
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit: 
> > http://www.trauma.org/traumalist.html
> >
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit: 
> > http://www.trauma.org/traumalist.html
>
>
> __________________________________________________
> Do you Yahoo!?
> Yahoo! Mail Plus - Powerful. Affordable. Sign up now. 
> http://mailplus.yahoo.com
>
>
>
>

--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/traumalist.html

List Archives

For your convenience, find the Trauma List Archive Below

Difficult airway