Replies to This Discussion

Permalink Reply by David McElroy on September 7, 2007 at 5:06pm

Here in NH EMT-I's are no longer using ETT's and are now using either Combi-Tubes, LMA's or King LTD's as a result of the new study by the AHA. Its basically Service/ MRH Option as to which one is used, I actually like the Combi-Tube. In Massachusetts EMT-I's are still using ETT's with LMA's as a back up.

Permalink Reply by Jason Brooks on September 7, 2007 at 8:30pm

We had a tough call where we tried intubation several times. We went to the combi-tube. It wouldn't work either. I had never even heard of this happening before. After being inserted and inflated, it popped out. Tried three times. Even the ED doc tried and same result. We bagged her all the way to the ER. She needed to be tubed due to a brain bleed and uncontrolled airway.

Permalink Reply by IDLHgirl on September 7, 2007 at 9:35pm

I am thinking we will be doing RSI in the future...I also think this will be an elective addition to our skills, with a lot of continuing ed. to stay up on it. I worked as a flight paramedic and we did do RSI when needed. It was required that we had at least 3 intubations per quarter, so 12/yr. If we didn't get tubes in the field we had to schedule time in the OR to get our tubes. I always walked out of there thinking I could tube anybody on the planet, because it is so good to spend a day doing nothing else....it definately builds your confidence. That said, the RSI drugs for the most part, were pretty user friendly because we mostly used "sux", etomidate, versed, and fentanyl. The dosage and conversion to cc's is simple, and easy to remember in the heat of the moment. The initial paralytics only last a couple of minutes, but you still feel a need to get that tube once you put somebody down. I think this is a skill you should use when there is nowhere to go but up, anyway...Some people won't want to do the constant required skill testing and cont. ed. to do this, but if a medic wants to do it and can keep up on it, it can be invaluable. I do sometimes hear of the idea to stop medics from intubating in the field, but I can't imagine they would stop us getting an airway that will quickly be lost....its not like its brain surgery. I hate the combi tube,personally....I have seen it tear up some tongues and airways, but the King LTD is pretty sweet. That could be an excellent substitute for the combi-tube, and is pretty much dummy-proof (even though we know there are some dummies out there to prove that theory wrong).

Permalink Reply by Jessica on September 9, 2007 at 7:54pm

Im definatly a fan of the tube. Ive used a combi tube twice and hated it both times. The first time with cuffs inflated we still got vomit out of both tubes and it was a huge mess and did no good we had to pull it. The second time it worked but as soon as we got to the ed they pulled it and put in a tube. I say if you can get the tube in the field ...DO SO. But I do agree that I believe we will all end up with RSI in the future. Much easier to use in troubling situations.

Permalink Reply by Carl Curtis on September 14, 2007 at 11:30am

I don't see us intubating patients much longer with the King LTD. In fact one county in Florida the medical director has replaced ET tubes with the King. In fact my medical director limites the amount of times our medic can attempt intubation, if we don't get it, then we move on to an LMA or Combitube.

Permalink Reply by Cody West on September 15, 2007 at 7:28am

I know in Combat, IF we could tube, the Combi's and LMA are supposed to be a first shot, can't miss. But I see the flip side of that being, Can a pt go into surgery with a combi tube in? Makes sense to me (EMT-B, USN Corpsman with 2 combat tours) that if you can get an ET Tube, go for it, Makes life easier down the line of the pt's treatment

Permalink Reply by Cody West on September 15, 2007 at 7:32am

Ok, Question from the new guy, what is RSI. Please be nice, I'm learning.

Permalink Reply by Cody West on September 15, 2007 at 1:29pm

Thanks buuba. Got a question. you prefer straight or curved ET blades, can't remember the names. The medic I worked with in Norfolk always used a straight blade.

Permalink Reply by Cody West on September 16, 2007 at 2:39am

Sounds good to me. Always appreciate the advice of those who have gone before me. So here is another question for everyone. I a looking at buying some EMT-P text and work books, don't know if I should go with Brady's, Mosby's or both. What is your opinions.

Permalink Reply by Andrew on October 24, 2007 at 3:26pm

I have been told by our assistant EMS director that paramedics using ETTs will soon be a thing of the past and that the biggest reason is that hospitals in Ga where I live will no longer allow medics to intubate during clinicals due to liability. I disagree with taking this out because we have always been taught that if you don't have an airway you don't have shit. If they do take out endotracheal intubation it won't be for long because they will have a lot of deaths due to aspiration of vomit, blood etc. Leave it to a bunch of dumbass docs to let this happen before they say hey maybe we shouldn't have done that, give me a seasoned medic over a doc anyday.

Permalink Reply by Roy Monson on November 7, 2007 at 2:17pm

We currently use ETT and LMAs as our back ups but rumor has it King are going to replace it all. Whatever is fastest and best for the pt. I really do not care.

Permalink Reply by Michael Corns on December 9, 2007 at 12:21am

I believe the questions is still open to future data collected. We have the opportunity to keep intubating as long as we always bring pateint's with a properly placed ET tube or no tube at all. Remember that not all patient's need a tube immediately. If there is any difficulty and you're getting good ventilations the tube should be forgotten about and get the patient transported. It's the misplaced ET tubes and the trauma caused by rough attempts that will be the downfall. We all must make certain we have competency in our intubation procedures if we expect confidence and continued support for field intubations.

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