C-spine collar to help secure tube

[MS Medic]

A C-Collar and a bougie are like using capnography to confirm tube placement. They're all tools to help us perform better. I don't know why anyone would say any of these are crutches.

 

[medicasaurus]

Problem is that C-Collars also have unwanted effects such as decreasing cerebral venous return and increasing intracranial pressures.

http://www.ncbi.nlm.nih.gov/pubmed/12121154
emj.bmj.com/content/18/5/380.full

 

[MS Medic]

I'm on shift right now so I'll read the study later when I get the chance but a concern over decreased venous return becomes irrelevant when a well intentioned But untrained FF dislodges the tube by rough handling. A good compromise that I will look into might be to pop the collar loose after the pt is loaded into the truck.

 

[triemal04]

I do not see much comparison to the hospital here. Patients get moved a lot in surgery, by a trained group of people who are used to moving intubated patients. The volunteer firefighters that are not even first responders? Not so much. I'm not sure how it was ever construed as a crutch, it's just a way to help.

Also the bougie comment caught my eye. In school we were taught to use the bougie 100% time if that's what we found that worked. ABout half of our ED physicians started using it on most cases this year after attending some sort of magical training. But it's a crutch right, because not everyone learned something that way?

Even with untrained people it doesn't take much to minimize the possibility of tube displacement. If the providers are doing thier job correctly this can easily be accomplished. I have no doubt though that often, due to lack of training, lack of familiarity with the process and situation, and excess adrenaline (aka panic) due to the above factors this is not possible. So, in that situation, while it may be needed, its because of a failure on the part of the provider, not because of real neccesity.

The bougie is a seperate topic, but the same idea. Like a c-collar, there cerainly are times when it is needed. BUT if a bougie is used each time instead of just being available each time, either the provider is a true phenomonam who only gets truly bad airways, or they are not competant at intubation or don't understand what they are doing.

There is nothing wrong with using a backup airway device or alternate means of securing a tube when the situation dictates it's use. But that does not happen each time; if it is the cause likely lies with the provider.

A C-Collar and a bougie are like using capnography to confirm tube placement. They're all tools to help us perform better. I don't know why anyone would say any of these are crutches.

See above. ETCO2 is very different from what is being discussed.

 

[TXmed]

So if I use a bougie every time, and am successful every time I use a bougie , I am not competant at performing Intubation?

 

[triemal04]

So if I use a bougie every time, and am successful every time I use a bougie , I am not competant at performing Intubation?

If you use it each time I think you don't completey understand what you are doing and aren't as good as you think you are.

Think of it like this: if I am a whiz at putting together a table and chair from Ikea that comes premade, with instructions and all needed tools, does that mean I am competant at building a table and chair from scratch?

 

[Underoath87]

If you use it each time I think you don't completey understand what you are doing and aren't as good as you think you are.

Think of it like this: if I am a whiz at putting together a table and chair from Ikea that comes premade, with instructions and all needed tools, does that mean I am competant at building a table and chair from scratch?

It means that you won't have to build a table from scratch, since you can always assemble one from Ikea...

It's not like we're using C-collars because we're not sure how deep the tube should be inserted. It's that things out of our direct control may cause the patient's head to move around, which could potentially cause dislodgement.

If you want a better analogy, it's like putting thread lock on a bolt when assembling some part of a car (or better yet, motorcycle, since mechanical failure would be more catastrophic). Is it absolutely necessary? No. But it is an extra safety measure in case **** happens and in no way reflects poorly on our abilities.

 

[triemal04]

It means that you won't have to build a table from scratch, since you can always assemble one from Ikea...

It's not like we're using C-collars because we're not sure how deep the tube should be inserted. It's that things out of our direct control may cause the patient's head to move around, which could potentially cause dislodgement.

If you want a better analogy, it's like putting thread lock on a bolt when assembling some part of a car (or better yet, motorcycle, since mechanical failure would be more catastrophic). Is it absolutely necessary? No. But it is an extra safety measure in case **** happens and in no way reflects poorly on our abilities.

Really? What happens when you lose the instructions or tools? Just give up and build a sofa instead? The problem with using a backup device each time, especially one as effective as a bougie, is it ups the odds of complacency tremendously, and allows people who arent really skilled and knowledgeable about something to do it. Instead of really having to be good at intubation, always having to properly position the patient, knowing to use laryngeal manipulation, occipital adjustments, or many other simple manuevers that will easily improve your view, a bougie is used from the get go...but what happens when the bougie doesn't work? Now all those simple and effective airway moves are not practised, likely not thought of, the patient was quite possibly in a crap position to start, the provider may never have been good at intubation and now they have no recourse except to use a SGA or BVM.

You can insert c-collar for bougie if you want.

Don't get me wrong, both devices have a role, it's just that they shouln't be needed each time.

 

[epipusher]

Hes the worlds best prehospital provider or a troll, not sure which one yet. Really enjoying your responses regardless!

 

[TXmed]

I'm pretty comfortable with my Intubation success rate. So I guess I will continue being an incompetent paramedic that uses the bougie for every tube, and uses etco2 and then puts on a c-collar. Just being incompetent

 

[triemal04]

I'm pretty comfortable with my Intubation success rate. So I guess I will continue being an incompetent paramedic that uses the bougie for every tube, and uses etco2 and then puts on a c-collar. Just being incompetent

That isn't quite what I said, but it's ok, you can take this personally if you want to.

 

[triemal04]

Hes the worlds best prehospital provider or a troll, not sure which one yet. Really enjoying your responses regardless!

I'm sorry, but can you explain what part is trolling? I always thought that was something different than having a dissenting opinion, but I could be wrong.

 

[MS Medic]

Since everything that needs to be said on the topic has been, can we lock the thread and stop the impending flame war please?

 

[MS Medic]

Since everything that needs to be said on the topic has been, can we lock the thread and stop the impending flame war please?

And paraphrasing the epic works of Forest Gump, that's all I have to say about that.

 

[chaz90]

There's no need to lock a thread as long as discussion is continuing and everyone remains civil. So far, this thread is still avoiding personal attacks for the most part.

Keep the discussion focused on the pros and cons of cervical collars to maintain proper placement of ET tubes and we can keep the thread open for now. There's valuable information here.

 

[jwk]

I think you guys are really missing the point.

Of course everyone should know how to properly tape a tube and transfer a patient. That's a given. No one is saying "hey bro - if you are having trouble with your tubes getting pulled, just start using a c-collar and your accidental extubations will go way down".

The c-collar is just a small extra measure of precaution - not unlike putting an extra piece of tape on the IV before you leave the ICU for the helicopter, or having that extra syringe of propofol already drawn up.

I see the point - I just don't agree with it much. Like I said before - it doesn't hurt anything. Does it help much? I doubt it - it's certainly not some magic cure-all or it would be used everywhere all the time.

 

[Underoath87]

I see the point - I just don't agree with it much. Like I said before - it doesn't hurt anything. Does it help much? I doubt it - it's certainly not some magic cure-all or it would be used everywhere all the time.

If that logic held true, backboards and epinephrine would be the most effective field treatments ever.

 

[CANMAN]

If it makes you feel warm and cozy then go ahead and apply a c-collar. I will never knock a provider for it, however to date I believe I have transported close to 1,000 intubated patient's that were either IFT on a vent, or a scene run and bagging at some point during the transfer, and have yet to have an ETT migrate or be lost on a transport. Secure your tube in whatever fashion your program, protocols, training, etc states, confirm placement before you move patient, confirm placement with movement/transfers, monitor waveform end-tidal, Spo2, etc. It's really that easy. Is it going to hurt anything? Not at all. Is it needed or going to save an incident likely to cause an accidental extubation? My opinion is no. It's an extra step, and extra cost, but like I said if it makes you feel better go for it.

 

[RocketMedic]

This incompetent paramedic uses a lot of VL and a bougie on every intubation and finds that they work pretty well to rectify his lack of daily real-world intubation experience.

 

[onrope]

Not a bad idea, any good paramedic will reassess tube placement every time you move the patient. One of the many benefits of waveform capnography is how easy it is to glance at the monitor and be 99% sure your tube is still good. I am required to fully immobilize any intubated PT under 8 years old.