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Fri, 5 Apr 2002 14:15:46 -0800 (PST)

John,
  Here, here.  I brought a gsw to the ED and watched an MD whom I respect do rsi (he was shot in the chin with no airway compromise).  It took the doctor more than eight minutes after the administration of paralytics (and an additional dose-not an option for me in the field) in a well-lit, well attended trauma bay to achieve intubation.  What are my chances in the back of a truck with perhaps one other paramedic (if I am lucky enough that day to have a paramedic partner)?  I don't like the odds.
PRhodes

--- Holmes John <Jholmes@mater.org.au> wrote:
>Jim - you promulgate a misconception I often hear from EMTs - namely that if
>only they had neuromuscular blockers then they could intubate antything.
>You need MORE than just a short acting neuromuscular blocker.    You need to
>be properly trained in all pharmacological and technical aspects of RSI &
>intubation.   This is not for the occasional practitioner.
>
>John L Holmes
>Director Emergency Medicine
>Mater Hospitals, Brisbane
> ----------
>From: James A. Johnson
>To: 'trauma-list@trauma.org'
>Subject: paralytics vs. surgical cricothorotomy in the field
>Date: Wednesday, 3 April 2002 10:25
>
>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