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Thu, 16 May 2002 20:21:14 EDT

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I wholeheartedly agree with Mr. Martin's view of obtaining a patent, secure 
airway in a trauma pt. who is entrapped in a vehicle for an extended period 
of time. We as pre-hospital practitioners, must not overlook the fact that 
endotracheal intubation is not just for those pt's. who are not breathing; 
but, also for those who are not breathing well, as well as those who can't 
protect their own airway. Let us not forget those pt's. who are 
decompensating, and will soon not be able to protect their airway or breathe 
well. I too, have incubated many pt's. in a variety of trauma incidents, 
especially those entrapped in vehicles. A number of techniques can be 
employed for successful endotracheal intubation. Personally, I have used 
nasotracheal intubation in those without obvious head or facial trauma. 
Endotracheal intubation for entrapped front seat occupants has worked well 
for me by simply laying on the hood of the vehicle (with the roof either 
removed or folded back) facing the pt. who is appropriately immobilized, and 
completely reversing the oral endotracheal intubation procedure, (holding the 
laryngoscope in my rt. hand, the tube in my left, and using downward, forward 
pressure to visualize the cords) facilitating tube placement. I have placed 
other airways successfully, by means of surgical cric. Arguably, the most 
ideal means of intubation, is with the pt. appropriately sedated and 
paralyzed, with complete exposure, adequate light and adjunct equipment. But 
rarely do all these conditions present themselves at the right time. 
Therefore, we must think, train, and prepare to work with the tools and 
knowledge we already have.

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<HTML><FONT FACE=arial,helvetica><FONT  SIZE=2>I wholeheartedly agree with Mr. Martin's view of obtaining a patent, secure airway in a trauma pt. who is entrapped in a vehicle for an extended period of time. We as pre-hospital practitioners, must not overlook the fact that endotracheal intubation is not just for those pt's. who are not breathing; but, also for those who are not breathing well, as well as those who can't protect their own airway. Let us not forget those pt's. who are decompensating, and will soon not be able to protect their airway or breathe well. I too, have incubated many pt's. in a variety of trauma incidents, especially those entrapped in vehicles. A number of techniques can be employed for successful endotracheal intubation. Personally, I have used nasotracheal intubation in those without obvious head or facial trauma. Endotracheal intubation for entrapped front seat occupants has worked well for me by simply laying on the hood of the vehicle (with the roof either removed or folded back) facing the pt. who is appropriately immobilized, and completely reversing the oral endotracheal intubation procedure, (holding the laryngoscope in my rt. hand, the tube in my left, and using downward, forward pressure to visualize the cords) facilitating tube placement. I have placed other airways successfully, by means of surgical cric. Arguably, the most ideal means of intubation, is with the pt. appropriately sedated and paralyzed, with complete exposure, adequate light and adjunct equipment. But rarely do all these conditions present themselves at the right time. Therefore, we must think, train, and prepare to work with the tools and knowledge we already have.</FONT></HTML>

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intubation of pt in vehicle