It was -4 when I started my truck this morning. Took me 10 minutes to start the damn thing though.
I haven't even started yet and I already hate Light Duty.
"Santa" looks like he's wearing PJs and a cheap piece of craft fur tied around his face! **is biased cuz her Pops is the ultimate Santa, even though he's hung up his boots for good**
I don't have RSI, we were 3 minutes away. His airway was perfect, no snoring respirations, and satting at 100%. He was just drunk.
No RSI needed. You have drug assisted crash airway? (Versed maybe)? And with a GCS of 3, you probably don't even need that.
I'm sure as heck not criticizing you. Jut remember that anyone that depressed, with that much of a toxic substance on board is at an EXTREME risk of loosing their airway in a flash. I know, I have had someone with a seemingly patent airway, and 30 seconds later, I am trying to move at light speed to get it back.
He vomits without an airway in place, and suddenly those are the longest three minutes of your life, plenty long enough for him to arrest.
Just my $0.02. But then again, I am pretty darn aggressive when it comes to airway management. More so than most I would think.
The answer to a potential airway problem is not necessarily intubation. If you are close to the hospital, I think BLS airway is probably the way to go, especially if you don't have a real RSI protocol (versed is a horrible drug to intubate on).
I think trying to intubate someone who has a patent airway and is breathing fine - especially when you are really close to a hospital - is a bad move.
Breathing fine has nothing to do with it. I could not care less. Breathing or not.
It is airway patentcy that I am concerned about. He has a high potential of loosing that patent airway so fast, you couldn't even get your suction turned on. The man has a GCS of THREE. You probably aren't even going to need drugs, for one. Crash him, tubed in 2-3 minutes, at the ER within 5-6. With a solidly patent airway.
BLS airway has it's place, don't get me wrong. But in my opinion, this is an ALS airway patient.
Part of the reason that is my opinion is because I would get called up by QA/QI and asked why he didn't get a tube. And as previously stated, I am rather on the aggressive side of airway management.
The problem with this approach is that it exaggerates the risk of monitoring the airway (vs. intervening) and completely ignores the significant risks inherent in prehospital intubation, especially when you don't have the ability to do RSI.
What do you mean you can "lose" the airway? What are you afraid of happening that can't be corrected with an OPA, good BVM skills, and suction? What are you afraid of happening that doesn't actually become MORE LIKELY during an intubation attempt, in which case you'l likely end up BVM'ing anyway?
Prehospital intubation is sometimes appropriate, but not always. It should not be the automatic default. It is often difficult and always risky for the patient. Not everyone who needs airway management needs an ET tube. BVM is not just a rescue technique.
Being "aggressive" is not always the best thing to do.
I made a thread on this a long time ago (Rapid Sequence Induction (RSI) HOWTO), read Manual of Emergency Airway, and read a ton of online articles and protocols on it. The answer is actually very variable, however, common initial dose seems to be 0.1 mg/kg over several minutes.I have 10mg of versed in my box. I have no protocol for drug assisted intubation. I wouldn't even know an appropriate dose.
Ugh I absolutely hate this time of year... Never really known why, but the past two or three years, the holiday season makes me even more depressed than usual... which tends to be a rather lot