Quote:
Originally Posted by ACE844
"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.
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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