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Rescue Airway Techniques

Simon Houstoun shoustoun at hotmail.com
Mon Apr 10 08:49:09 BST 2006


It's not a dark medical conspiracy and the points about 'daddys car' i.e. 
patient 'matching' were meant to be tongue in cheek and refer to the real 
world problem of trying to achieve homogeneity in a non-homogenous patient 
set
Cheers
Simon


----- Original Message ----- 
From: "paul.middleton" <paul.middleton at usa.net>
To: "'Trauma &amp; Critical Care mailing list'" <trauma-list at trauma.org>
Sent: Sunday, April 09, 2006 7:13 PM
Subject: RE: Rescue Airway Techniques


> Ashton
>
> That was a marvellous summary and an exemplar of clear thinking. Some of
> your more experienced colleagues might learn something by listening. The
> sooner you get out on the road full-time the better for the patients in 
> your
> neck of the woods!
>
> The argument truly should be about how the patients threatened airway may
> BEST be protected until they arrive at the safest situation for more
> definitive management (if needed), and not about the laboured 
> justification
> of only one way to manage the situation. These conversations would, in a
> world less dominated by entrenched positions and rigid thinking, contain
> more about how we can ALL innovate / research / improve other alternatives
> that don't have the associated iatrogenic morbidity and mortality. For
> goodness sake, it doesn't all have to be about ETT's and laryngoscopes, 
> and
> it shows little respect for other people on this list to start making
> childish comments about Daddy's car or such other nonsense. It also shows
> little capacity to understand the whole reason for evidence based health
> care.
>
> The nonsense about some dark medical conspiracy to keep "tricks" in 
> hospital
> and away from anyone else is such patent bullshit it should be in the 
> pages
> of the National Enquirer or the Fortean Times, alongside the UFO's and
> alligators in the sewers of Brisbane!
>
> Paul
>
> Dr Paul M Middleton
> RGN MBBS FRCS(Eng) DipIMCRCS(Ed) FFAEM FACEM
>
> Emergency Medicine
> Sydney
> Australia
>
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org 
> [mailto:trauma-list-bounces at trauma.org]
> On Behalf Of Ashton Treadway
> Sent: Sunday, 9 April 2006 5:08 PM
> To: Trauma &amp, Critical Care mailing list
> Subject: Re: Rescue Airway Techniques
>
> Hi:
>
> I'd like to pile onto this excellent message (thank you for a
> brilliantly written contribution, Scott), I recently completed an ACLS
> course at which this topic came up in side discussion.
>
> For me, with my admittedly limited perspective as a paramedic student,
> the debate over whether or not we (EMS) should be performing
> intubation breaks down into a long, but pretty clear question:
>
> "Is it in the /patient's best interest/ for prehospital providers to
> be attempting and often failing ETT insertion, especially when there's
> strong evidence that excellent BLS skills with a BVM and/or other
> adjucts such as the CombiTube and LMA provide the same effective
> airway stabilization with much less risk?"
>
> I will also point out an elephant in the room: it seems to me that a
> non-trivial percentage of medics are fighting against losing
> intubation not on medical or evidentiary grounds, but on the grounds
> that it erodes their scope of practice, and makes them, if you will,
> less powerful. To put it bluntly, that's a crappy reason, and, for me
> at least, it calls into question the credibility of anyone making that
> argument.
>
> I also have problems with the argument that we (EMS) are "just as good
> as" in-hospital providers at intubation: we are not, based on all the
> available evidence. And, in this case, not being the worst does not
> stand in some rank of praise: even if we aren't killing more people
> than those folks in the hospital, our success percentages are dismal.
>
> So.
>
> As a cohort, we are failing, approximately, 1 out of 4 intubations in
> the field, with dire consequences. I'd submit to you that, in the face
> of the evidence that good BVM and BLS skills can do just as well as an
> ETT, and that other airways such as the CombiTube and LMA can provide
> comparable protection, the question is no longer how we improve
> intubation percentages.
>
> The question is, instead, "what's in the patient's best interest?" Are
> we serving that interest, or serving our own?
>
> Respectfully,
>
> Ashton
>
> On 4/6/06, HAXScott at aol.com <HAXScott at aol.com> wrote:
>>
>> Melissa,
>>
>> I'm a paramedic, and while I empathize fully with some of your
> frustration,
>> I must respectfully disagree with several of your points.
> [eloquence trimmed]
>
>> In a message dated 4/6/2006 8:53:17 AM Eastern Standard Time,
>> mmarkey at hallrender.com writes:
>>
>> With all  due respect, I have a different suggestion - how about
>> anesthetists and  anesthesiologists willingly sharing their knowledge and
>> giving paramedics  more chances to practice intubation in a controlled
>> setting
>
> [trimmed]
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