Cut vs uncut tubes

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I'll disagree with Mark's last sentence. Pprovided the personnel are
appropriately trained there is NO problem with uncut tubes! Having been
on the receiving end of cut tubes in rapidly swelling burnt patients I
can tell you it is no fun at all having to change these tubes. The NSW
Ambulance Service has only carried cut tubes from the beginning of the
paramedic service in 1976, but is about to (thankfully) abandon that and
only use uncut tubes. The risks of inserting a tube that is too short,
and subsequently needs to be changed [and we see this at least once a
month], is much greater than the risk of an endobronchial tube, in the
hands of a trained operator.

Cheers, Ian

Ian Seppelt FANZCA FJFICM
Senior Staff Specialist
Dept of Intensive Care Medicine
The Nepean Hospital, PO Box 63 Penrith NSW 2751
Director of Clinical Research, Sydney West AHS
Clinical Lecturer, University of Sydney

>>> atacc.doc at btinternet.com 21/09/2007 2:53am >>>
HI Tug, 
Although a longer tube and your catheter mount will increase the dead
space, in adults this volume will have little effect as compared to the
overall tidal volume of 6-7ml/|Kg. 
Children are a very different affair and ideally with small children
and babies (<25Kg and below to pick a number!) your breathing system
should connect directly to the tube, as even 10-15mls could be
significant.

Uncut ET tubes are always a controversial area. In major facial trauma,
burns or other conditions producing major swelling then they are
appropriate, but in most other circumstances they can produce problems
with endobronchial postioning, migration and kinking.

Mark F
UK

----- Original Message ----
From: "tuganddawn at talktalk.net" <tuganddawn at talktalk.net>
To: trauma-list at trauma.org 
Sent: Thursday, 20 September, 2007 12:45:54 PM
Subject: Dead space


Hello everyone,

   I recently had a conversation with a Paramedic colleage who
suggested that if you intubate a patient (prehospital) with an uncut ETT
you should not use a cobb connector (the corrugated plastic tubing
betweeen BVM and tube) because of the excessive dead space created.
Though I appreciate that we are using manual ventillation I disagreed
with this in adult patients due to the relatively small size of these
connectors.
   I appreciate that this is an extremely basic question but I am
curious to see what the consensus is.
   Thanks for your time and patience ladies and gents and look forward
to your responses.

  Take care and Kindest Regards

FF Tug Crumpton SR para
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