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Fri, 5 Apr 2002 15:00:36 -0900

please explain how you get shot in the chin with no airway comprmise, and if
there was no airway compromise why was the ER wonder intubating? and during
this eight minutes did he stop to reoxygenate?
Jim Johnson
> -----Original Message-----
> From:	patricia rhodes [SMTP:prhodes@paramedicine.com]
> Sent:	Friday, April 05, 2002 1:16 PM
> To:	trauma-list@trauma.org
> Subject:	RE: paralytics vs. surgical cricothorotomy in the field
> 
> 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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> >
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paralytics vs. surgical cricothorotomy in the field