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Rescue Airway Techniques

HAXScott at aol.com HAXScott at aol.com
Thu Apr 6 21:42:21 BST 2006

Amen brother - if it's not the physicians, it's the nurses... haha.  
(kidding, I  know many of my respected colleagues who are nurses are on  this 
listserve). The profession has all the potential in the world, but needs a  great deal 
of work... and it has come a long way since Johnny an Roy called  Rampart to 
ask if they could put their EOA in... But we have 'our' problems. The  day 
they decide to take the laryngoscopes away in the urban areas (where I would  
venture to guess that in many, but not all, urban areas with rapid access to  
tertiary care assets, the majority of intubations are 'crash' airways of  
patients who are in arrest or agonal or minutes from death), the IAFF will come  out 
in a great blue wall and protest the physicians who they'll claim are trying  
to stop the brothers from saving lives. 
I'm no angel. I've used a laryngoscope as a pry-bar. I've sprayed a fair  
amount of brutacaine, and I've titrated midazolam and morphine so that I put my  
patient in exceptionally grave danger in the hopes of looking really cool in  
front of the cute EM residents at Yale (of course, then I really, really 
thought  in my heart of hearts it was in the sick person's best interest as well). 
I'm  not so convinced now for the patients in the city, where, again, I tend 
to think  most of the patients getting intubated are codes. The other patient 
populations  we intubated back in the day were people in acute pulmonary edema 
- and finally,  prehospital CPAP is emerging as a standard of care - and 
trauma patients, in  whom there may be little or no survival benefit. 
My honest opinion: some paramedics should intubate. Some shouldn't. Some  
physicians shouldn't be allowed to touch a laryngoscope either, but I think  
that's a much more complicated problem than the urban paramedics who arrive in  
packs of 6, and each gets a chance with their blade of choice (or two). If you  
work in a city, arrive as a six-pack of multimedics, have infrequent airway  
encounters, don't have close, intense medical director involvement in your  
practice, and don't have a rigorous PI process... perhaps you, as a paramedic,  
should be trying to have your own laryngoscopes taken away. 
I hear a rumor the Europeans are onto something with prehospital trauma  
intubation (by anesthetists!) using the FasTrach LMA, and not laryngoscopy.  
Perhaps someday, Dr. Archie Brain will be the Ross Perot of medical  devices.

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