intubation as a basic skill

[MeaganIV]

Meagan-

First I will tell you I am going to be starting my fourth 48 hour shift in 2 weeks tomorrow, so it may be day or two before I can read your response....

I understand your point that ET intubation should be a paramedic procdure. Its an ALS skill, Medics are ALS. But what I would like you to help me understand is your belief that intubation is harder than starting IV's, because in most cases I would strongly disagree with that.

I dunno. I just do. Its the same reason why some people thing that intubating is easier.


We all have our strengths and weaknesses. I didn't mean to step on anyone's toes and I'm sorry if I've offended anyone but we've all got our opinions and that one was mine.

Thanks.

 

[jakobsmommy2004]

Basics can't intubate in Indiana, and if I heard anyone around here suggest that they be able to do so, I think I would have to knock some sense into them. At the basic level we most certainly do not receive the education needed to go along with the skills training and, unfortunately, I don't see that changing anytime soon. You can train a monkey to do just about anything, but that doesn't mean you should.

i dont understand. i had a excellent instructor that has 20plus years in the field. you are acting like just because we are "basics" its like we are 10 year olds trying to do surgury. we are all adults here with an education. so you are saying if one of your family or somebody needed to be intubated you are going to have a fit because there are only basics on the sene to do that. are you gonna let them die because you believe its not right to have a basic do it and there is not a paramedic on the scene?

just my 2 cents

 

[Mercy4Angels]

they dont teach us that here. if you have to intubate get medics fast. See here in New Jersey there is no EMT-I just basic and paramedic and the basic dosent intubate. Sure i would like to know how to do it but i guess that will come when i go for EMT-P

 

[Ridryder911]

i dont understand. i had a excellent instructor that has 20plus years in the field. you are acting like just because we are "basics" its like we are 10 year olds trying to do surgury. we are all adults here with an education. so you are saying if one of your family or somebody needed to be intubated you are going to have a fit because there are only basics on the sene to do that. are you gonna let them die because you believe its not right to have a basic do it and there is not a paramedic on the scene?

just my 2 cents

First, intubation is far more than just a procedure. If you do not know that or aware of that, then you do not need to be intubating or understand the respiratory/pulmonology physiology. Do you understand Mallampati grade, chord damage, right main stem bronchial intubation, Bleb's, tidal volume amounts?

It is not the procedure of performing the skill of raising a tongue and exposing the glottic opening. Same as an IV is simple enough to "train" anyone above the age of 6 to perform these procedures, however only those that have the understanding and in-depth of these systems should perform these procedures. It is knowing why, the dangers, the actions to take if these procedures fail, and what to do after these procedures have been performed that really counts.

There is a reason it is considered an advanced level skill. If one wants to perform advanced procedures, then one should attend advanced level classes to be able to do so. Never attempt to compare skills with knowledge.

p.s. correct spelling.... surgery.

R/R 911

 

[Mercy4Angels]

i agree. Theres a difference between just doing it and understanding it. Thats not to say you can never do it you just would have to take the proper courses at an advanced level to really understand it.

 

[trauma1534]

THe thing about intubation is that it actually does require more skill then you think.

Its dangerous, invasive, and has consequenses especially when trying to place it.


It should not be a basic skill because it is NOT basic.

It is more dangerous to give D-50 than it is to intubate!!! Point blank, to the point. If you can't get a good airway by bagging, you have to be able to do something. No airway= no life!!!

 

[trauma1534]

We always employ the most basic maneouvers first. Thats the way it is. If I have a Pt who is in a hypoglycemic state and they can talk to me and follow commands and swallow I will administer oral glucose even though I do have D50W at my disposal and I have already established an IV line.

If I can secure the airway with an OPA or NPA then thats what I'll do. advanced airways are for enroute.. not for on scene.

Approx how many ALS calls have you actually been on??? You mean to tell me that you would actually take the time to put in an OPA or NPA at the scene in a secure environment over getting that patient tubed and securing the airway??? My God!! Where do you practice??? You need more experience before you can come in here trying to stand up to the big dogs! You should not be in the EMS field if you are afraid of something as simple as an ET!!!Furthermore... EMS is about giving the very best treatment for your patient right then and there. You have to stay ahead of the game!!! If you hold back, then your patient will get away from you! That's streight up! EMS is a think quick and do now thing, not wait till they get so far down the drain you can't pull them out! That is crazy!!!

 

[MeaganIV]

Approx how many ALS calls have you actually been on??? You mean to tell me that you would actually take the time to put in an OPA or NPA at the scene in a secure environment over getting that patient tubed and securing the airway??? My God!! Where do you practice??? You need more experience before you can come in here trying to stand up to the big dogs! You should not be in the EMS field if you are afraid of something as simple as an ET!!!Furthermore... EMS is about giving the very best treatment for your patient right then and there. You have to stay ahead of the game!!! If you hold back, then your patient will get away from you! That's streight up! EMS is a think quick and do now thing, not wait till they get so far down the drain you can't pull them out! That is crazy!!!

Hhahaha man, this is getting blown way out of proportion. I am not afraid to do it, I just believe that in the time it takes to shove a tube down someones throat I could have inserted my OPA, began artificial vents and performed half of my rapid physical.

We're all supposed to employ the most basic methods first. Thats just the way it is. It is think quick but it's also do quick. If an OPA is good enough to get that Pt oxygen then thats what I'm gonna do.

I'm not here to try and change minds or sway ppl to see it my way. I'm just here to put in my opinion. This is what I was taught and I agree with it. I'm sorry if that upsets you but thats the way it is.

ETs require a lot of knowledge about pulmonology, respiratory, and what might happen. Such as a laryngeal spasm. If you irritate the vocal cords and close the airway, then you're not gonna be giving the Pt any O2 either... in anyway.

ETing isn't the only way to do it.

 

[Ridryder911]

Approx how many ALS calls have you actually been on??? You mean to tell me that you would actually take the time to put in an OPA or NPA at the scene in a secure environment over getting that patient tubed and securing the airway??? My God!! Where do you practice??? You need more experience before you can come in here trying to stand up to the big dogs! You should not be in the EMS field if you are afraid of something as simple as an ET!!!Furthermore... EMS is about giving the very best treatment for your patient right then and there. You have to stay ahead of the game!!! If you hold back, then your patient will get away from you! That's streight up! EMS is a think quick and do now thing, not wait till they get so far down the drain you can't pull them out! That is crazy!!!

Actually, and legally one is supposed to place an airway in the patient and ventilate up to 3 minutes prior to intubation! You intubate the patient in my state and not licensed as an advanced or student, I see you at the State Dept hearing. This is the proper way for testing for the NREMT/ Advanced airways skill station.

If you do not know how to control an airway with BLS skills, such as oropharyngeal or nasopharyngeal airway with BVM, then you are not qualified to intubate ... period!

Come and play with the real "big dogs" of anesthesiology, which most in residency have to control airways for the first 6 months with proper head alignment, O.P's, N.P's etc.. then they get to intubate.

R/r 911

 

[YYCmedic]

Approx how many ALS calls have you actually been on??? You mean to tell me that you would actually take the time to put in an OPA or NPA at the scene in a secure environment over getting that patient tubed and securing the airway??? My God!! Where do you practice??? You need more experience before you can come in here trying to stand up to the big dogs! You should not be in the EMS field if you are afraid of something as simple as an ET!!!Furthermore... EMS is about giving the very best treatment for your patient right then and there. You have to stay ahead of the game!!! If you hold back, then your patient will get away from you! That's streight up! EMS is a think quick and do now thing, not wait till they get so far down the drain you can't pull them out! That is crazy!!!

I'd always try to get an OPA in any environment before even considering tubing them. Why would you go putting in tubes if an OPA works just fine? In fact I believe if someone from a review board read on any one of my PCR's that I just went ahead and tubed my pt. without trying any BLS level airway control I'd probably have my license up for review. I agree that EMS is about giving your pt the best care possible, so why would you put a tube down their throat if you didn't have to? By staying ahead of the game you should have an ET tube on hand incase your pt. starts to go downhill, not shove a garden hose down their throat immediatley on the small chance that they might, possibly, may crash on you. That also seems like a malpractice case waiting to happen.

 

[MeaganIV]

I'd always try to get an OPA in any environment before even considering tubing them. Why would you go putting in tubes if an OPA works just fine? In fact I believe if someone from a review board read on any one of my PCR's that I just went ahead and tubed my pt. without trying any BLS level airway control I'd probably have my license up for review. I agree that EMS is about giving your pt the best care possible, so why would you put a tube down their throat if you didn't have to? By staying ahead of the game you should have an ET tube on hand incase your pt. starts to go downhill, not shove a garden hose down their throat immediatley on the small chance that they might, possibly, may crash on you. That also seems like a malpractice case waiting to happen.

Wow. TJ come to the rescue. Thanks for the back up, sweets.

 

[Fedmedic]

I'd always try to get an OPA in any environment before even considering tubing them. Why would you go putting in tubes if an OPA works just fine? In fact I believe if someone from a review board read on any one of my PCR's that I just went ahead and tubed my pt. without trying any BLS level airway control I'd probably have my license up for review. I agree that EMS is about giving your pt the best care possible, so why would you put a tube down their throat if you didn't have to? By staying ahead of the game you should have an ET tube on hand incase your pt. starts to go downhill, not shove a garden hose down their throat immediatley on the small chance that they might, possibly, may crash on you. That also seems like a malpractice case waiting to happen.

Well, I don't know the way everyone else was taught. But I was taught to "secure" the airway, not to just "control" it. If your patient has an OPA or NPA in and vomits your in deep s***. If my intubated patient vomits, I don't care because I have a secure airway. Now if you had the ability to intubate and secure it but didn't and the patient aspirates on vomitous, now let's talk about negligence and lawsuits and review boards. You keep doing it your way and I'll keep doing it mine. I've been playing this game a long time my way and haven't went before any review boards or had any lawsuits filed against me. But I have received numerous commendations.

 

[Nycxice13]

Thats a valid point but if its that bad then why wouldn't dispatch just send ALS or have ALS standing by?

Im in NYC, in NYC traffic, can you honestly in all seriousness, tell me that ALS is 2 minutes away? POINT

 

[Mercy4Angels]

not in NYC unless its frekin 3am. Luckily here in jersey ALS is maximun 5minutes out.

 

[MeaganIV]

Im in NYC, in NYC traffic, can you honestly in all seriousness, tell me that ALS is 2 minutes away? POINT

Usually. Yeah.

ALS intercept isn't far away. The same with the FD and the police.

 

[Ridryder911]

Even intubated patients can aspirate (albeit mor difficult), but if your patient vomits one should be able and be ready to suction. Intubation is the "gold standard" as log as one has adequate education and clinical skills, thus this would and should move them to the advanced level.

Again, even most surgical procedures are very simple and non-complex, yet we don't just allow anyone to perform them. The same should be true on all and any medical procedures. One should possess a thourough understanding of the effects of all and any treatment, procedures, anatomy, patho-physiology and several hours of clinical practice before allowing one to proceed as part of their certification.

R/r 911

 

[jeepmedic]

Well, I don't know the way everyone else was taught. But I was taught to "secure" the airway, not to just "control" it. If your patient has an OPA or NPA in and vomits your in deep s***. If my intubated patient vomits, I don't care because I have a secure airway. Now if you had the ability to intubate and secure it but didn't and the patient aspirates on vomitous, now let's talk about negligence and lawsuits and review boards. You keep doing it your way and I'll keep doing it mine. I've been playing this game a long time my way and haven't went before any review boards or had any lawsuits filed against me. But I have received numerous commendations.

Same folks taught me. And I have been before review boards and on them. I ahve yet to be repremanded for my Airway skills, or practice's. Driving now that is a diffrent story.:blush:

As for OPA, that is a good way to check for a gag reflex.

 

[Nycxice13]

Usually. Yeah.

ALS intercept isn't far away. The same with the FD and the police.

Are you nuts?

 

[Fedmedic]

As for OPA, that is a good way to check for a gag reflex.

As a matter of fact, that is my rule of thumb; if they will take an OPA then they will take a tube.

 

[Mercy4Angels]

Are you nuts?

gotta remember where some of us are comming from. im in union county NJ and ALS is only minuts away tops. I have spent alot of time in the city and surrounding areas and unless you can fly i cant imagine ALS getting there faster than 12 minutes on a very good day.