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This study just came out in Annals of EM. It says that prehospital intubation causes long stoppages in CPR which is a big no no under the new guidelines.
This study just came out in Annals of EM. It says that prehospital intubation causes long stoppages in CPR which is a big no no under the new guidelines.
So would it be best to Combitube the pt, since this will decrease time spent intubating?
It seems as though the prevailing wisdom at this point is not going toward replacing endotracheal intubation with King or Combitube but to abandon advanced airway altogether in favor of BLS airway with uninterrupted CPR.
Throw that in with the existing data regarding decrease coronary artery perfusion pressure with even a brief interruption in chest compressions and it makes the case even more for compression only. Just throw on a NRB and OPA and maybe a C-collar to maintain good head position and start pumping away !
You can attempt to intubate during compressions, too...
as good mask technique really takes three people.
Yeah, but I am lazy. It's easier to place a King and keep going with the code. That and I am not exactly intubating multiple patients a day, therefore I am not to proud to say I am probably more effective at utilising a supraglottic airway.
No offence but if you have let your skills slip to the point you are too lazy to even try you need to turn in your medic patch and go back to being an EMT. This attitude is why EMS is seeing a back lash in recent times. People too lazy to keep up there own skills and other too lazy to try the hard but yet more effective road. I will admit flying in the chopper with RSI has made it easier to get more tubes but when I was on the ground every chance I got I would at least attempt and ET before just dropping in a king tube. If the FD already had a king tube in place and I was feeling good I could get the tube I would pull it and drop an ET. You can tube while compressions are going on and it should take you no longer than 30 secs to do. Sounds like you should seek out some Retraining...
My major issue with this is does this really help your patient?
I have seen ET tubes come into the ER placed in the esophagus. If it anecdotal hour at SDN, I am sure we have all sorts of stories relating to these devices. However, the bottom line being, we have allot of evidence based literature stating that intubation does not make a difference in cardiac arrest. In some cases, such as the study this thread is based upon, intubation may be harmful. Therefore, it is acceptable to consider alternatives to intubation.
Additionally, I do not consider transitioning to a supraglottic device or simply sticking with mask ventilation lazy. (In spite of my comments made in jest.) I simply do not see the benefit of intubating these patients. In addition, one of the most objective measure I have available for placement verification (capnography and capnometry) is not always accurate in low perfusion states. I am simply not willing to take such a risk when evidence supports a more conservative methodology as being just as effective.
The ER replacing a supraglottic airway with an ET tube is a price of tea in China argument IMHO. I am also not keen on replacing functional supraglottic airways in the field. The old saying the enemy of good is better applies in some cases, and I am willing to be much more conservative if the conservative modalities are working. Additionally, I am not a paramedic and have no patch to turn in.