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Tue May 10 22:32:17 BST 2005

I´m agree with Claudia again, our team do all the transfers from México to
Shriners Galveston as the Medical Director for the Program our protocol is
to intubate all patient in which we suspect airway injuries until we made
the broncoscopy to rule out this injury after that we can extubate the
patient so
Not intubate on the field unless unstable, better indoor than in the
aircraft and further  evaluation by bronchoscopy

-----Mensaje original-----
De: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]En
nombre de Claudia Burrows
Enviado el: Martes, 10 de Mayo de 2005 02:06 p.m.
Para: Trauma & Critical Care mailing list
Asunto: RE: intubation in burn patients

My thought process was as follows: if this patient is in an outlying ER, he
needs to go to a burn center. If I am (personally) called upon, then he is
going to be flown (I am a flight medic). If I am going to fly him then I am
going to intubate him BEFORE getting in the aircraft. As you say, it is
easier to intubate in the controlled setting of the ER than in the aircraft
(or in a car upside down, or blah, blah, blah). I would not feel comfortable
making a 25+ minute flight with this patient unintubated due to the
potential for an unstable airway and/or respiratory mechanics/effort (due to
chest burns and/or pain medication). I still say I would RSI and intubate
him. NOW, if YOU are the MD at a BURN center and he is STAYING at your
facility, that is a whole 'nother ballgame. Make sense?

Claudia Burrows (cum alphabet)

-------Original Message-------

From: Robert Smith

Date: 05/10/05 10:59:07

To: 'Trauma & Critical Care mailing list'

Subject: RE: intubation in burn patients

I think that is a good point. The patient didn't need to be intubated in the

field, but rather in resus.

R. Smith, MD

-----Original Message-----

From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org
>mailto:trauma-list-bounces at trauma.org">trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]

On Behalf Of medic245 at mindspring.com

Sent: Tuesday, May 10, 2005 7:35 AM

To: Trauma & Critical Care mailing list

Subject: Re: intubation in burn patients

-----Original Message-----

I think this is where nurses and doctors and medics thoughts diverge. Yes,

I

was concerned about his airway--ie the singed nasal hairs but he was in NO

resp distress-no signs of impending distress, stridor, coughing, wheezing

and

only slightly increased resp rate @24-26.

-----------------------------

I don't know if it's a diversion of thought process, or just an example of

judicious utilization of resources, coupled with sound judgement.

For all the banter given by paramedics about how we "can intubate anyone,

under a car, upside down in a ditch, at 3 am, in the rain, blah blah blah,"

the fact is quite simple: It's easier to intubate in a well lit resus room,

with lots of people, space, equipment, and back-up options.

Understand that if the patient in this scenario had signs of airway

compromise more serious than singed nares (stridor, hoarseness, resp.

distress, etc.) I would RSI him in the field without a second thought. But

as you describe the patient, the prudent decision is to transport promptly

to the aforementioned well-lit resus room where the aforementioned people,

space, equipment, and back-up options are located.

Medicine is about knowing what to do when, but it's also about knowing when

NOT to do something. The "When" part is what they teach in school. The

"When Not" part is for you to learn on your own, and much more difficult to

comprehend.

Best,

Jeff Brosius

Paramedic, etc.

Phoenix

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intubation in burn patients