View Full Version : S.A.L.T. - Supraglottic Airway Laryngopharyngeal Tube
Everyone,
I saw this being discussed elsewhere and thought some of the folks here might be interested in it. I have no commercial and or personal interest in the product. It would seem to me that there could be a number of safety concerns with the device and in regards to iatrogenic trauma as a result of it's use. I guess I'm one of those old school folks who believe there is a reason that the 'gold standard' is visualization of the cords and watching the ETT pass through. Additionally there is little info out there about patients who art anterior and posterior, etc.., and this devices use. However, I could also see where this device could be an invaluable tool in confined spaces and other areas and situations where access to the patient is limited.
Esentially it seems that the basic idea is that you place the SALT just like you would a combitube. You place the device in the oro-pharynx by just just blindly pushing it in. Once it's in as far as it goes, you insert an ETT down the slot, and secure it with the strap that comes with the device.
The manufacturer is reporting that so far, there is a low rate of missed ET intubations.
Manufacturer's page for the product.
http://www.mdimicrotek.com/prod_salt.htm
Youtube demonstration video
http://www.youtube.com/watch?v=VHaIufNEjXU
Hope this helps,
ACE844
Surgicalcric
02-13-2010, 21:11
Nice, another single purpose item to take up more space in my already over-stuffed -with single use items- aidbag...
Seriously though, it looks like a nice piece of kit to have on the Bus and I can recall more than a couple instances where I could have, and probably would have used it back when I was still on the street.
If it proves successful (thru trials) it may provide BLS responders another means of securing an airway instead of the traditional ETT skill that so many Med Control docs wont sign off on... Having said that I can see EMT-P's becoming dependent on the SALT due to its ease of use and thus lose the ability to tube a pt the "old fashioned"way. Maybe, maybe not...
Crip
Nice, another single purpose item to take up more space in my already over-stuffed -with single use items- aidbag...
Crip
"Crip,"
It just might come in handy at that next MRAP roll over you work on one of those 'slow snowy southern nights' you seem to be having as a result of global warming...:D:D:D:p
Brush Okie
02-13-2010, 21:51
Looks like a solution to a non existant problem IMHO. With the old school ETTand other advanced airways out there already I really don't see a use. Worse than that it is an attempt to replace training with a piece of gear, never a good thing IMHO. ETT's are not that hard to do. The reason MD's do not want to sign off on ETT's has more to do with ego and politics than skill. An ET can be inserted with a person trapped in a car if it needs to be.
Looks like a solution to a non existant problem IMHO. With the old school ETTand other advanced airways out there already I really don't see a use. Worse than that it is an attempt to replace training with a piece of gear, never a good thing IMHO. ETT's are not that hard to do. The reason MD's do not want to sign off on ETT's has more to do with ego and politics than skill. An ET can be inserted with a person trapped in a car if it needs to be.
"Brush Oakie,"
With respect I disagree with you on your point as to why many MD's are hesitant and apprehensive about pre-hospital intubation. It seems the docs are less keen to 'sign off' on pre-hospital ETT as a result of pre-hospital educational issues, skill retention, and basic competency, and experience with the procedure. Dr Wang and a few other docs have a number of good journal articles on the matter in the journal of pre-hospital emergency care, Journal of Emergency Medicine and others..
It seems that on second blush that just some of the many issues present are the 'docs' lack of confidence in pre-hospital providers ability to safely and effectively perform a necessary and critical skill. This is what causes their lack of support for the intervention.
Brush Okie
02-13-2010, 22:24
"Brush Oakie,"
With respect I disagree with you on your point as to why many MD's are hesitant and apprehensive about pre-hospital intubation. It seems the docs are less keen to 'sign off' on pre-hospital ETT as a result of pre-hospital educational issues, skill retention, and basic competency, and experience with the procedure. Dr Wang and a few other docs have a number of good journal articles on the matter in the journal of pre-hospital emergency care, Journal of Emergency Medicine and others..
It seems that on second blush that just some of the many issues present are the 'docs' lack of confidence in pre-hospital providers ability to safely and effectively perform a necessary and critical skill. This is what causes their lack of support for the intervention.
I am relating my experance. When I was in that field I usually had two jobs. In one area I could and did ET's on a regular basis. In another area we could do them but they would not let us jump through the hoops to get signed off for a couple of years even after being in the protocols. Finally a couple of us were allowed to certifiy and paved the way for the rest. The problem at that time and there was as I stated above. Some MD's were supportive and got it pushed through, but several of the MD's in the community stalled it due to their ego's. BTW that was not only my opinion but the opinion of most medics, ER nurses and several MD's that supported us doing it. Your experance is probably diffrent than mine.
I was an assistant instructer for one course and have seen some other classes. It seems to me many times the skill training was geared twords passing the skills test, not real world. When I was a precepter and instrucer I put my students through all kinds of situations. I made them intubate with the dummy sitting up to simulate a person trapped in a car, on the floor, in cramped space etc. I didn't scream and yell I taught. I am afraid many times students are taught cook book medical not to think. The MD's need to address the ilness not the symptoms. Just my opinion. That and $3.00 will get you a fancy cup of coffee.
Red Flag 1
02-14-2010, 17:36
"Brush Oakie,"
With respect I disagree with you on your point as to why many MD's are hesitant and apprehensive about pre-hospital intubation. It seems the docs are less keen to 'sign off' on pre-hospital ETT as a result of pre-hospital educational issues, skill retention, and basic competency, and experience with the procedure. Dr Wang and a few other docs have a number of good journal articles on the matter in the journal of pre-hospital emergency care, Journal of Emergency Medicine and others..
It seems that on second blush that just some of the many issues present are the 'docs' lack of confidence in pre-hospital providers ability to safely and effectively perform a necessary and critical skill. This is what causes their lack of support for the intervention.
ACE,
My training and practice of anesthesia started in 1975 and concluded when I retired just after 9/11. I taught airway management to medical students, residents and practicing physicans. Anesthesia folks are the recognized experts in airway management. My exposure with pre-hospital patient care has been limited to teaching. I expect that there is some hesitation in "signing-off" on this device relative to a few issues.
As mentioned, the "gold standard" of airway management is endotracheal intubation by direct visulazition; no question there IMO. The second choice is via fiberoptic placement. Even using "gold standard" intubation means, the experts can run into problems. If one of my students related to me that he/she could intubate anything, that was the student I would watch closely. Even under the best of situations, a sure endotracheal intubation must be checked with a breath sounds, and x-ray if needed; I have been fooled. Enter then the foolproof, blind intubation.
Blind intubation is just that. The hope is that the anatomy is "normal" . The hope is that the blind intubation device works as advertised. There have been a host of blind devices that have gained support, EOA for one had ACLS support, that was later found to be too dangerous to support continued use. I am not sure that SALT is any closer to the blind intubation answer that airway experts will sign off on. I could be wrong. Being retired, I've not used the device. I will look into SALT and talk with folks who have professional experience, then make an informed call. There are providers on this board who may have experience with SALT.
Bottom line is that a patient arriving in the ER with an ETT in place, by any means, will have ETT placement verified by all necessary means. This is not a reflection on the person who placed the ETT, nor any in the EMT community; simply sound medical practice. I like Bursh Okie's teaching approach, did the same myself. If there is an answer to difficult ETT placement, my vote is with fiberoptic assistance. It is more expensive. I doubt Crip will be able to find room to carry all that is needed for fiberoptic ETT. EMT crews are better positioned to bring fireroptics to support patients in need.
Be well!!
RF 1
"RF1,"
I agree wholeheartedly with you..