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Tue Jan 9 06:15:20 GMT 2007

LanceO Oosthuizen <LanceO at sedibeng.gov.za> wrote:
  Hi All I am an ALS paramedic from SA just south of Johannesburg. Just recently I 
received a call of a male patient 29 who came off a quad bike in a remote area 

Lance,

Ouch! You paint an ugly picture. If this is accurate, the ER doc messed up and you proved it to him and everybody else. His training and experience needs to be reviewed by somebody responsible for him. There may or may not be a problem with the physician, in that we all have knowledge gaps that need to be filled. He found his, and now he has an opportunity to fix it.

I would move to obtaining a surgical airway only if the patient is hypoxic and difficult to ventilate, or, if I have reason to suspect that this will rapidly occur due to some clinical situation (maxillofacial injury with hemorrhage). Nonetheless, I would have someone else continue to ventilate and attempt to intubate while I was performing the procedure, and I would abort the cric if intubation was successful. Did this just the other day, in fact. I felt kind of stupid having to consult surgery to close the incision, but...if my colleague was unable to get the tube, well, you see the dilemna that we are faced with in airway problems. Hypoxia is so unforgiving.

DB

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