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Airway Management

2. 2004 Ronald Pristera. Why?. Growing body of literature that suggests that pre-hospital providers are not proficient at airway managementUndiagnosed eso intubationsPoor assessment skillsLack of practiceAdvanced directivesHospice Progressive protocols. 3. 2004 Ronald Pristera. Primum non noce

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Airway Management

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    1. Airway Management Back to the basics

    2. 2 2004 Ronald Pristera Why? Growing body of literature that suggests that pre-hospital providers are not proficient at airway management Undiagnosed eso intubations Poor assessment skills Lack of practice Advanced directives Hospice Progressive protocols

    3. 3 2004 Ronald Pristera Primum non nocere An increase in mortality has been documented in association with paramedic rapid sequence intubation (RSI) of severely head-injured patients. This analysis explores the impact of hypoxia and hyperventilation on outcome. The impact of hypoxia and hyperventilation on outcome after paramedic rapid sequence intubation of severely head-injured patients. Davis DP, Dunford JV, Poste JC, Ochs M, Holbrook T, Fortlage D, Size MJ, Kennedy F, Hoyt DB.

    4. 4 2004 Ronald Pristera Primum non nocere During the six-month study period, 208 out-of-hospital intubations by ground paramedics were enrolled, which included 160 (76.9%) medical patients and 48 (23.1%) trauma patients. A total of 12 (5.8%) endotracheal tubes were incorrectly placed outside the trachea. Emergency physician-verified out-of-hospital intubation: miss rates by paramedics. Jones JH, Murphy MP, Dickson RL, Somerville GG, Brizendine EJ.

    5. 5 2004 Ronald Pristera Primum non nocere However, ETI requires skills which are difficult to maintain especially if practised infrequently. The laryngeal tube (LT) has been successfully tested and used in anaesthesia and in simulated cardiac arrest in manikins. To compare the initiation and success of ventilation with the LT, ETI and bag-valve mask (BVM) in a cardiac arrest scenario, 60 fire-fighter emergency medical technician (EMT) students formed teams of two rescuers at random and were allocated to use these devices. We found that the teams using the LT were able to initiate ventilation more rapidly than those performing ETI (P < 0.0001). The LT and ETI provided equal minute volumes of ventilation, which was significantly higher than that delivered with the BVM (P < 0.0001). Our data suggest that the LT may enable airway control more rapidly and as effectively as ETI, and compared to BVM, may provide better minute ventilation when used by inexperienced personnel.

    6. 6 2004 Ronald Pristera Primum non nocere Adequate oxygenation at all times is of paramount importance to the critically injured patient to avoid secondary damage. The role of endotracheal intubation in out-of-hospital advanced trauma life support, however, remains controversial. Initiated by a recent observational study, this commentary discusses risks and benefits associated with prehospital intubation, the required personnel and training, and ethical implications. Recent evidence suggests that comprehensive ventilatory care already initiated in the field and maintained during transport may require the presence of a physician or another adequately skilled person at the scene. Benefits of such as service need to be balanced against increased costs

    7. 7 2004 Ronald Pristera

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