Guest guest Posted October 22, 2006 Report Share Posted October 22, 2006 The practice of cutting ET tubes for pre hospital use was established, (in Australia that is), for two reasons. 1. less tube protruding during difficult egress and transport. 2. less chance of pushing the tube too far. If an ET tube is to be used through a surgical cric, it needs to be cut much shorter, but you're right about that. It is generally not done in hospital and the practice is under debate as far as I know since it might compromise the " sterility/cleanliness " of the tube. Cheers Gösta Cutting ETTs? All, It's probably just a symptom on my Americanitis, or because I just started paramedic school here in NYC, but I'm unfamiliar with the concept of cutting down ETTs. The only thing I can think of cutting a tube down for is a surgical cric, where you'd want it shorter because you're skipping the upper airway and don't want 6 " of tube floating around above the site begging to be dislodged. Could someone elaborate a bit for me? Thanks in advance. -bill sterile? it must be Italian Bill EMT-B murphquake@... Member Information: List owner: Ian Sharpe Owner@... Editor: Ross Boardman Editor@... ALL list admin messages (subscriptions & unsubscriptions) should be sent to the list owner. Post message: egroups Please visit our website http://www.remotemedics.co.uk Regards The Remote Medics Team Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 22, 2006 Report Share Posted October 22, 2006 Cut the ETT short to reduce dead space, reduce work of breathing (if spont resps), reduce ventillator pressures, and therefore aid CO2 clearance. Best Regards Brando Dr Brando C C Tamayo Staff Anaesthetist (Military) Queen andra Hospital www.porthosp.nhs.uk >From: " Bill EMT-B " <murphquake@...> >Reply- > >Subject: Cutting ETTs? >Date: Sun, 22 Oct 2006 18:25:44 -0400 > >All, >It's probably just a symptom on my Americanitis, or because I just >started paramedic school here in NYC, but I'm unfamiliar with the >concept of cutting down ETTs. The only thing I can think of cutting a >tube down for is a surgical cric, where you'd want it shorter because >you're skipping the upper airway and don't want 6 " of tube floating >around above the site begging to be dislodged. Could someone >elaborate a bit for me? Thanks in advance. >-bill sterile? it must be Italian > >Bill EMT-B >murphquake@... > > >Member Information: > >List owner: Ian Sharpe Owner@... >Editor: Ross Boardman Editor@... > >ALL list admin messages (subscriptions & unsubscriptions) should be sent to >the list owner. > >Post message: egroups > >Please visit our website http://www.remotemedics.co.uk > >Regards > >The Remote Medics Team > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 22, 2006 Report Share Posted October 22, 2006 Bill: This technique is not common here north and west of your local either.... In fact those on my truck.... a rookie had this bad habit of pre-introducing wire stylettes and attach a 10 cc syringe and place it in the now exposed wrapper..(I quote: To save time at a code) he received severe tongue lashings by the seniors on car, as many of us do not even use a styllette....... In fact " chopping " of the ETT prior to CXRAY evaluation is a huge NO NO in the ICUs were I have worked...punishable by slow, systematic ridicule by the attending MDs in ICU or ER.....with the exception of " prep " after confirmation of position, for bronchosopy or in long term ventilated patient's and with In -Line suction catheter's... We have a term for the overly short ETT...its called the " Cigar " but then you would even " seen " a good Cuban....lol. ps we use Shileys for trachs for crichothorotomy with my present employer, we changed out the " Quick Trake " when I came on board, they suck arse. Agreed with Brando re: deadspace, introducing an ETT actually reduces normal physiological VD/VT. But PIP ? not really negligible (and NOT trying to start a debate here) it could improve ventilator triggering dependant on flow/pressure sensitivity settings, if the patient cannot " trigger " and the ETT length of tube is a viable consideration then back to a Rest Mode would be my best and humble advice. CO2 elimination? personally I try to measure and match and intrinsic PEEP. cheers Wilf Cut the ETT short to reduce dead space, reduce work of breathing (if spont resps), reduce ventilator pressures, and therefore aid CO2 clearance. Best Regards Brando Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 22, 2006 Report Share Posted October 22, 2006 The trick my ICU attending used to make this point (and we can all do this at home) was to have us breath through a coffee stirrer straw. He slowly cut it down a centimeter at a time until it was almost at our lips. You'd be suprised how greatful you feel at that point. It definately makes weanng patients from the vent much easier. It also makes it less likely you will kink the tube with the heavy vent tubing. One important caveat: don't cut below where the pilot ballon comes off the tube or you'll drop the cuff. I don't teach this to my street medics (not relevent in the short term and risk of dislodgment is high whne you pull of the 15-22 mm adapter) but I do for critical care tranport and remote classes. Regards Jonnathan --- Brando Tamayo <drbcct@...> wrote: > Cut the ETT short to reduce dead space, reduce work > of breathing (if spont > resps), reduce ventillator pressures, and therefore > aid CO2 clearance. > > Best Regards > > Brando > > Dr Brando C C Tamayo > Staff Anaesthetist (Military) > Queen andra Hospital > www.porthosp.nhs.uk > > > > > >From: " Bill EMT-B " <murphquake@...> > >Reply- > > > >Subject: Cutting ETTs? > >Date: Sun, 22 Oct 2006 18:25:44 -0400 > > > >All, > >It's probably just a symptom on my Americanitis, or > because I just > >started paramedic school here in NYC, but I'm > unfamiliar with the > >concept of cutting down ETTs. The only thing I can > think of cutting a > >tube down for is a surgical cric, where you'd want > it shorter because > >you're skipping the upper airway and don't want 6 " > of tube floating > >around above the site begging to be dislodged. > Could someone > >elaborate a bit for me? Thanks in advance. > >-bill sterile? it must be Italian > > > >Bill EMT-B > >murphquake@... > > > > > >Member Information: > > > >List owner: Ian Sharpe Owner@... > >Editor: Ross Boardman Editor@... > > > >ALL list admin messages (subscriptions & > unsubscriptions) should be sent to > >the list owner. > > > >Post message: egroups > > > >Please visit our website > http://www.remotemedics.co.uk > > > >Regards > > > >The Remote Medics Team > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 26, 2006 Report Share Posted October 26, 2006 In UK most anaesthetist will have the tubes cut down eg size 9 ET cut to 24. Reason to much tube left has a chance of kinking whilst the procedure is in progress. Then a gain this also depends on the procedure and type of tube; armoured ET tubes are not cut. Any further information can be found on the Anaesthetic web sites in the UK. Sterility/cleanliness, most tubes are opened and preparied prior to the patient entering the operating theatre. not so long ago most A & E departments had a board on the wall with brackets attached and all tubes were open and on the board ready for use. Cutting ETTs? All, It's probably just a symptom on my Americanitis, or because I just started paramedic school here in NYC, but I'm unfamiliar with the concept of cutting down ETTs. The only thing I can think of cutting a tube down for is a surgical cric, where you'd want it shorter because you're skipping the upper airway and don't want 6 " of tube floating around above the site begging to be dislodged. Could someone elaborate a bit for me? Thanks in advance. -bill sterile? it must be Italian Bill EMT-B murphquake@... Member Information: List owner: Ian Sharpe Owner@... Editor: Ross Boardman Editor@... ALL list admin messages (subscriptions & unsubscriptions) should be sent to the list owner. Post message: egroups Please visit our website http://www.remotemedics.co.uk Regards The Remote Medics Team Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 3, 2007 Report Share Posted February 3, 2007 It may be the case here that a certain Offshore Medical provider has an instructor who told the students to cut down the ETT tubes. This is fine but his inference was to do it for storage for quick application when needed. Now, not sure how many ETT's you guys use but I have used absolutely zero for a few years. CAn't imagine the attending MO being happy with you using an ETT that had been basically left unwrapped in a medical kit for up to two years. Gosta Liljeqvist <gosta@...> wrote: The practice of cutting ET tubes for pre hospital use was established, (in Australia that is), for two reasons. 1. less tube protruding during difficult egress and transport. 2. less chance of pushing the tube too far. If an ET tube is to be used through a surgical cric, it needs to be cut much shorter, but you're right about that. It is generally not done in hospital and the practice is under debate as far as I know since it might compromise the " sterility/cleanliness " of the tube. Cheers Gösta Cutting ETTs? All, It's probably just a symptom on my Americanitis, or because I just started paramedic school here in NYC, but I'm unfamiliar with the concept of cutting down ETTs. The only thing I can think of cutting a tube down for is a surgical cric, where you'd want it shorter because you're skipping the upper airway and don't want 6 " of tube floating around above the site begging to be dislodged. Could someone elaborate a bit for me? Thanks in advance. -bill sterile? it must be Italian Bill EMT-B murphquake@... Member Information: List owner: Ian Sharpe Owner@... Editor: Ross Boardman Editor@... ALL list admin messages (subscriptions & unsubscriptions) should be sent to the list owner. Post message: egroups Please visit our website http://www.remotemedics.co.uk Regards The Remote Medics Team Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.