LMA

• Previous message: LMA
• Next message:
• Messages sorted by: [ date ] [ thread ] [ subject ] [ author ]

Not sure about protocols overseas, but I am uncertain about some comments
made so far. For my services protocols, LMA is not indicated in a patient
with a patent, secure airway who is a short distance from hospital. That is
just common sense (to me a least), why do something that is not required.
However, in our great wide brown land (Australia), even in busy Melbourne
(pop. 4 million and 300,000 calls per year for 1,000 ambos), we regularly
have transport times 20min plus and no pre-hospital doctors.
You come up with a better way of managing an unsecure or soild airway or
ventilating a patient with a BVM driving down the road for 20min and I'll be
more than happy to listen. Yes, our service recognises the ETT as the gold
standard, but also acknolwedges skills maintenance/training to be an issue,
so only intensive care paramedics are trained in its use, unfortunately they
are not always available or nearby.
If funding and resources were unlimited we would all be intensive care
paramedics and there would be more hospitals but we can only hope. If anyone
has the solution to all these problems listed above and not just complaints
about the quality of pre-hospital care, I'd be happy to implement them.

Nanto Cielens

----- Original Message -----
From: "Dunn Matthew Dr. (RJC) ACCIDENT & EMERGENCY - SwarkHosp-TR"
<matthew.dunn@swarkhosp-tr.wmids.nhs.uk>
To: <trauma-list@trauma.org>
Sent: Wednesday, April 03, 2002 1:13 AM
Subject: RE: LMA


> > <<The whole benefit of prehospital intubation in trauma patients is
> > unclear.>>
> >
> > Really? I don't think that it is unclear at all. It must be
> > performed as
> > early as possible (when indicated) by a competently trained
> > practitioner of
> > whatever level -- physician, paramedic, whatever.
>
> No, it remains unclear. There is little/ no evidence for its benefit.
> (Efficacy- yes: you can find individual cases where prehospital intubation
> probably saved a life. Effectiveness- no: there is not the evidence that
> introducing prehospital intubation as a skill improves mortality. If
> anything, the UK experience at least shows critically ill and trauma
> patients to do better when attended by crews without these skills).
> Prehospital intubation certainly carries some very real risks that may
> cancel out (on a population basis) its benefits in the cases where well
and
> correctly applied. It delays transfer to a definitive care facility; is
> usually carried out by practitioners less experienced and with less backup
> (including more advanced surgical airway skills, fiberoptic laryngoscopes,
> other staff); and in a more hostile environment than in hospital
intubation,
> so the likelihood of complications is higher.
> A patent airway can usually be maintained by simple techniques (chin
lift).
> If you have a patient who requires to have their airway secured; you have
a
> practitioner at scene; there are no other problems that are likely to
> deteriorate due to delays in transfer for intubation ( concealed
haemorrhage
> etc); and transfer times are long, intubation is probably intubated. In
> cases with short transfer times to facilities where there is a more
> experienced practitioner with better backup on site; the patient has
ongoing
> uncontrolled haemorrhage; it is a difficult intubation etc. you should
> consider whether it is appropriate to intubate on scene. It is unlikely in
> many EMS setups that many individual practitioners will be able to
maintain
> competence at intubating rapidly with use of drugs and without
complications
> simply by normal day to day practice (if restricted to patients who will
> benefit from prehospital intubation). You therefore have to question how
> much time (and risk to patients) should be taken up by providing ongoing
in
> hospital experience to those practitioners. Of course, this argument does
> not apply to setups where physicians who regularly work in anaesthesia or
> emergency medicine rotate to spending time responding prehospital (often
by
> helicopter).
>
> Matt Dunn
>
>
> This email has been scanned for viruses by NAI AVD however we are unable
to
> accept responsibility for any damage caused by the contents.
> The opinions expressed in this email represent the views of the sender,
not
> South Warwickshire General Hospitals NHS Trust unless explicitly stated.
> If you have received this email in error, please notify the sender.
>
>
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/traumalist.html

• Previous message: LMA
• Next message:
• Messages sorted by: [ date ] [ thread ] [ subject ] [ author ]