PAI vs. RSI

[Guest guest]

With regard to Dr. Bledsoe's statement about PAI, I would have to say that

the jury is also still out on this.

Archie Brain, the inventor of the LMA, promotes PAI with Versed. He does

not share the concerns expressed by Dr.Bledsoe. Neither does Frasse,

inventor of the Combitube.

Jim Rich, CRNA, Executive Director of SLAM and a CRNA with 27 years

experience in intubating, teaches it and does not share Dr. Bledsoe's concerns.

That said, it is obvious, or it ought to be obvious, that before one

performs ANY advanced airway procedure s/he ought to be completely familiar with

all

the effects of each and every drug given, plus have the ability to think

critically about what one is doing, and adapt to changing circumstances.

It is my belief that few paramedics practicing today actually have the amount

of education and training in airway management to be cut loose with any of

the sedative or paralytic drugs. However, it is also my firm belief that they

can readily be given the requisite education and training in good programs.

Versed or etomidate can be used to assist in intubations in COPD, asthma, and

CHF patients, without paralyzing them. I have done it many times, and I

have never had an adverse outcome. On the other hand, I have at times seen

that paralysis was necessary and proceeded to do that. As the song goes,

" You've got to know when to hold em, and know when to fold em. "

Paramedic education is getting worse, not better, in the area of airway

management because it is so hard to get medics into the OR to intubate.

Further,

OR experiences are often terrifying to the medic, particularly if there's a

gas passer who's impatient, hostile, threatening, and basically not helpful in

teaching the student. I've seen that numerous times, and it's happened to

me.

Perhaps the use of cadavers will be a part of the answer. When I was

learning, after a code was called in the ER, the physicians made every effort

to

allow the medics to intubate. Now, residents don't even get to do that for

fear of lawsuits.

Further, Medicare won't pay a physician who doesn't do the procedure

himself, so that's another reason that physicians don't want students

intubating.

Resident physicians don't even get to do surgeries for the same reason.

Perhaps we ought to focus at least some of our energies on improving the

educational opportunities for those folks who are going to be intubating us or

otherwise taking care of our airway needs.

Finally, with the advent of the intubating LMA, all this may be moot.

Gene G.

E.(Gene) Gandy

POB 1651

Albany, TX 76430

wegandy1938@...