NG Tubes and Airway Management

[usalsfyre]

I've seen plenty of Combitubes in hospitals but not Kings.

They're getting more common in airway carts. The problem with Combitubes is the tracheal tears.....

 

[18G]

I thought most were going with the King mainly because it was latex free whereas the Combitube is not and it is slightly easier to insert and train on.

 

[BandageBrigade]

ET Tubes are not the only airway devices Hospitals have & use...

I never started they were. I was just starting that it was odd that the OR only uses LMAs as a backup while The ER only uses Kings. In the age of cost cutting you would think they would just use one or the other. Im sure each director just has his/her opinion on which is better.

 

[jwk]

I never started they were. I was just starting that it was odd that the OR only uses LMAs as a backup while The ER only uses Kings. In the age of cost cutting you would think they would just use one or the other. Im sure each director just has his/her opinion on which is better.

LMA's are a primary device in the OR (not just as a backup) and it is commonly used in cases that don't require endotracheal intubation. The King airway is primarily a rescue airway when endotracheal intubation isn't possible, and has found little use in anesthesia and the OR. You will however find them on difficult airway carts in a lot of OR's and ER's to have on hand just in case. We've never had to use them.

 

[18G]

What type of NG tube are most using prehospital? The salem sump or single lumen levin type tubes?

I have seen the salem sump tubes used the most in and out of the hospital. So just curious.

 

[8jimi8]

What type of NG tube are most using prehospital? The salem sump or single lumen levin type tubes?

I have seen the salem sump tubes used the most in and out of the hospital. So just curious.

What I've seen prehospital is a Salem sump. In the hospital it is either Salem sump,OG, or a do dobhoff ng/nd/nj

 

[ShotMedic]

18 Gauge I agree with you for the placement of NG/OG tubes in the Pre-Hospital setting if theres enough time to do so. I work in the Rural San Diego County Area with most of our first responders BLS. With our ALS ETAs from 5-25mins to the scene I know how BLS CPR can cause major Gastric Distention and adversely effect the ventilation of the Patient as well as the Effectiveness of the Chest Compressions. Our normal transport times to the closiest hospital is 15 mins to 1hr If the helicopters arent available. We utilize the dual lumem levin, I havent had any trouble inserting it in the Intubated Patient. the King Airways have a Port that a 18gauge or smaller NG tube will slide down on certain model. I have yet to use that on scene but I hear it works well. I will Admitt I have not Had time to place the NG/OG tubes in every Patient due to many reasons but having the tool available never hurts.

 

[jwk]

18 Gauge I agree with you for the placement of NG/OG tubes in the Pre-Hospital setting if theres enough time to do so. I work in the Rural San Diego County Area with most of our first responders BLS. With our ALS ETAs from 5-25mins to the scene I know how BLS CPR can cause major Gastric Distention and adversely effect the ventilation of the Patient as well as the Effectiveness of the Chest Compressions. Our normal transport times to the closiest hospital is 15 mins to 1hr If the helicopters arent available. We utilize the dual lumem levin, I havent had any trouble inserting it in the Intubated Patient. the King Airways have a Port that a 18gauge or smaller NG tube will slide down on certain model. I have yet to use that on scene but I hear it works well. I will Admitt I have not Had time to place the NG/OG tubes in every Patient due to many reasons but having the tool available never hurts.

I assume you mean 18F, not 18ga.

 

[ShotMedic]

hhaha yeah thanks for the catch

 

[Ridryder911]

With what we use these for I think a protocol for radiographic confirmation is a necessary evil. I have seen many times... Ng and og tubes end up in the trachea.

18g,Have you seen how much people gag when you use these devices?

What x-ray for an NG tube?..OMG I have never ever seen such! Somebody screwed up big time somewhere or the radiologist needs some extra cruise trips! I can't imagine the cost for such a simple procedure! Listen auscultate and verify.. sorry, even with low suction.. either you have gastric contents or not...

NG tubes are placed daily, thousands of times without any extra verification in NH, home health for tube feeding, pre-hospital environment.

To the post, NG or OG to decompress the stomach to prevent pressure which causes vagal stimulation and on ped's is essential to perform and prevent!

I rarely see OR's use ETI anymore in the surgical arena, YES they use LMA type devices called fastrach I have a video of them utilizing and intubating through it.. It is easier, less traumatic on the patient and less complicated for short procedures...

http://www.youtube.com/user/Ridryder#p/a/u/0/HXjPdNSL96c

R/r 911

 

[jwk]

I rarely see OR's use ETI anymore in the surgical arena, YES they use LMA type devices called fastrach I have a video of them utilizing and intubating through it.. It is easier, less traumatic on the patient and less complicated for short procedures...

I use ETT's every day in the OR. We also use LMA's, but the LMA FastTrack is more of a rescue device that's not intended for routine use. It is a far more expensive device than the disposable LMA's we use daily.

 

[usafmedic45]

They're getting more common in airway carts. The problem with Combitubes is the tracheal tears.....

'

You mean esophageal tears. That's a problem with any object blindly and forcefully rammed down the throat of another. And, yes, I do mean any.

LMA's are a primary device in the OR (not just as a backup) and it is commonly used in cases that don't require endotracheal intubation.

Actually, they are used in cases that require ETI or rather a protected airway. It's just they use them instead of intubating. You actually have to be more out of it to have an LMA placed than to have an ETT passed.

 

[jwk]

Actually, they are used in cases that require ETI or rather a protected airway. It's just they use them instead of intubating. You actually have to be more out of it to have an LMA placed than to have an ETT passed.

Those statements are incorrect. There are specific indications and reasons why we use one or the other. If a case "requires" an ETT, then that patient will get an ETT. Many anesthetists are getting fairly cavalier about the use of LMA's in cases that really ought to have an ETT. I've never been sorry about placing an ETT, but there have certainly been times I didn't when I wish I had.

"More out of it"? Hmmmm, by what measure? LMA's are far less stimulating than laryngoscopy, and are easily placed a few seconds after induction, unlike ETT's where we wait for the muscle relaxants to kick in. LMA's are routinely placed before giving narcotics - not so with ETT's where virtually every patient will get narcotics during induction to blunt the sympathetic response to laryngoscopy.

 

[usafmedic45]

Those statements are incorrect....where we wait for the muscle relaxants to kick in.

Define "we". What's your role in all of this?

LMA's are far less stimulating than laryngoscopy, and are easily placed a few seconds after induction,

You can place an ETT in a conscious patient with local anesthesia or even in a fully conscious patient sans any anesthesia if you go via the nasal route. Unless your patient is Jenna Jamison, you're going to have to have them completely obtunded if you want to use an LMA.

All of the anesthesiologists I know- and I talk to a lot of them since I speak about difficult airway management and keep in touch with folks to stay up to date- freely admit they use the LMA over the ETT in most cases not to avoid any clinical aspects of standard intubation, but rather because it's quicker and there's somewhat less liability involved (no risk of breaking someone's teeth which is a large source of risk for anesthesiologists traditionally).

 

[jwk]

Define "we". What's your role in all of this?



You can place an ETT in a conscious patient with local anesthesia or even in a fully conscious patient sans any anesthesia if you go via the nasal route. Unless your patient is Jenna Jamison, you're going to have to have them completely obtunded if you want to use an LMA.

All of the anesthesiologists I know- and I talk to a lot of them since I speak about difficult airway management and keep in touch with folks to stay up to date- freely admit they use the LMA over the ETT in most cases not to avoid any clinical aspects of standard intubation, but rather because it's quicker and there's somewhat less liability involved (no risk of breaking someone's teeth which is a large source of risk for anesthesiologists traditionally).

I'm chief anesthetist for one of the largest anesthesia groups in the country, have been in practice more than 30 years, and am in the OR daily. While in college many years ago, I worked for both rural and urban EMS to pay my way through school, back in the days when IC injections and lots of bicarb were still in vogue and there was no such thing as ACLS. I'm still a clinical instructor in anesthesia and taught airway management and ACLS to paramedic students for years.

 

[18G]

To the post, NG or OG to decompress the stomach to prevent pressure which causes vagal stimulation and on ped's is essential to perform and prevent!
R/r 911

Thank you.

 

[usafmedic45]

I'm chief anesthetist for one of the largest anesthesia groups in the country, have been in practice more than 30 years, and am in the OR daily. While in college many years ago, I worked for both rural and urban EMS to pay my way through school, back in the days when IC injections and lots of bicarb were still in vogue and there was no such thing as ACLS. I'm still a clinical instructor in anesthesia and taught airway management and ACLS to paramedic students for years.

Really now...that's very interesting.....