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Rescue Airway Techniques

JanyaUC at aol.com JanyaUC at aol.com
Fri Apr 7 05:44:46 BST 2006

that didn't drain my shield too much at all... ;-)
your last paragraph surprised me. i in no way think you should just tube  
but if you are clearly not breathing/barely breathing or about to stop  
breathing in the field..whether due to inj from trauma or just medical  
problems....why not tube or use another type of airway securing device. do you  propose 
these pts get bvm'd the whole way to me?
regardless of the pts injuries...is your first priority not to secure an  
"What you believe to be such
common sense is, in fact likely KILLING  many of your
>>>>if the pt isn't breathing then they are dead....you can  only help from 
i was going to respond specifically to several of your comments but i just  
keep coming back to the same thing......there's a reason why you need ABC's  
without them nothing else matters.  
in my years in the icu and e.r. i have only ONCE known for sure that a pt  
died as a result of an esophogeal intubation. and that pt was intubated by a Dr. 
 in the er before being shipped to us. that same Dr read the post intubation 
xray  and got it wrong. how do i know this..a copy was sent with the pt. many 
errors  occurred leading this pt to code enroute to  *my* trauma room.   this 
20yr old's death is one of those that will never leave me...so please don't  
think that i take any of what i discuss lightly or flippantly. 
all that being said i'm a firm believer in the saying ...keep it  simple 
does the pt have a good airway??? if not get one!!
is the pt breathing??? if no the do it for them and please don't tell me  
that bvm is sufficient
i'm up to 4cents now....

In a message dated 4/6/2006 11:37:06 P.M. Eastern Daylight Time,  
aneurysm_42 at yahoo.com writes:

That's  the problem.

There is too much reliance on opinion and  "experience"
and not enough on science.  Your own statements  "...I
just don't see what all the hoopla is about..." makes
that  ABUNDANTLY clear.  Please I encourage you to read
some of these  studies.  What you believe to be such
common sense is, in fact likely  KILLING many of your

The unfortunate part of prehospital  practice is that
you don't have the opportunity to see the benefit  or
consequence of interventions made in the field;
especially in  patients who may have a prolonged acute
inpatient stay (like head  injury).  There is a
perspective you gain when you make a decision  to
intervene and you are able to gauge over a period of
time (not just  immediately) whether the patient does
WELL as a result or SUFFERS  unnecessarily from it.  

This research gives that perspective  without the EMT
or paramedic having to follow a patient over the span
of  months.  It shatters the mythical bravado many
attach to the  technically simple act of inserting an
ET tube; that in reality it's not as  simple as we all
assumed it to be.  Why is that?     

I don't think anybody on this list should carte
blanche stop  intubating patients simply based on a few
studies without any sort of  consensus; I am NOT
suggesting that.  

But in those patients  who "don't really need a tube"
or who are very marginal you might want to  take a
couple of moments to consider that what many would
consider a  necessary and appropriate intervention
could be potentially MORE lethal  than the original
indication for performing it.

Ben Reynolds,  PA-C
Pittsburgh, PA

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