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Wed, 3 Apr 2002 17:12:33 -0600

Jim:

In my emergency room, I would prefer a crico-thyroidotomy for this patient.
There is a problem with paralytic agents + intubation, which you do not
mention.

This patient has a severe closed injury.  Aren't you worried about worsening
a possible C-spine injury by the attempt at paralysis + intubation?  As your
sponsor says, this can be abused in the field...

Cricothyroidotomy has its own problems, but can often be done quicker and
with less risk to the C-spine.

Barry Armstrong.

-----Original Message-----
From: James A. Johnson

Subject: paralytics vs. surgical cricothorotomy in the field

I had a trauma pt with a closed head injury secondary to snowmachine
accident. pt was unconscious/unresponsive, no other trauma noted pt resp.
rate 32-34 irreg. pt jaw clamped. unable to call life flight due to weather.
ground transport time code red 20-25 min. to a non trauma E.D. 5 mins. into
transport pt began to show signs of posturing and started vomiting, pt had
to be rolled and suctioned but was unable to clear airway effectively. Pt
then started to brady down to the 30 despite bvm assist. in our service as
an  EMTIII we are able to provide many advanced skills and we have
progressive standing orders, however it's been a fight to get the sponsoring
physician to allow paralytics in the field. stating he feels it may be
misused in the out lying areas who have lower run volumes and weaker skills.
My thoughts are if they lack the skills don't let them use it, other
thoughts from the paramedics I have spoken to feel a cric is preferred. I
would rather use a short acting drug to allow me to tube than cut someone's
throat, because I feel if the attempt is missed I can go back to the BVM,
and oral airway. comments please.

Jim Johnson EMT III

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paralytics vs. surgical cricothorotomy in the field