Guest guest Posted August 5, 2009 Report Share Posted August 5, 2009 Severe burn patients with airway swelling shut. The burns can be thermal or chemical. And there are other times such as anaphalaxis non responsive to the meds. Remember I am in rural areas and at times a long way to a hospital. Airway closes w/o tube you are not going to be able to ventilate. You are just going to watch the person die. And as I mentioned earlier this may not change the ultimate outcome but w/o them getting to the hospital alive they have 0% chance. Maybe my patient will be the +-1% and actually survive because they had airway secured. I do not want to say well studies say you will die anyway so we are just going to sit here and attempt to force air past you closed off airway, please quit struggling the studies say it doesn't matter anyway. And hey studies never make mistakes so so long. I don't know about you but if I get to them alive I want to be able to keep them alive to the hospital. I have had some die in the ambulance and I understand that is part of what we do. In fact I hate when people say no one dies in my ambulance, what a load of poop. I understand the studies say ultimately it seems not to change outcomes, well if we get them to the hospital alive we have changed outcome at least for a little while. I do agree maybe we should use a simple adjunct and if effective save the intubation for the controlled environment of the hospital. But not all patients can wait. Again no disrespect meant to you more experienced Paramedics than I am. No disrespect meant to anyone and I am not trying to argue, I just can not see the benefit of completely removing something that can benefit some patients even if in a very low percentile. Thanks for putting up with my worthless thoughts. Renny Spencer Paramedic > > I think you're missing his point, Renny. > > Which ones of your patients are the ones that will not make it the ER > alive without intubation? How do you know that they couldn't have done > as well with say, a King airway or an LMA? We've all had patients that > we're fairly certain would have done poorly without advanced airway > management. But who is to say that advanced airway management > necessitates an ET tube? > > I'm not going to trot out the tired " anecdote does not equal data " > argument, but Kenny has a point, one I think everyone is missing: > > We intubate a lot of people. Thus far, we have a number of studies that > show that a few services excel at the skill, and a great many more suck > at it, but we have ZERO studies that show even a correctly placed tube > improves outcomes. And until we have *data* and not *anecdote* that > shows a demonstrable benefit, for however small a subset of patients, we > need to be a lot more judicious in who and how often we tube. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 5, 2009 Report Share Posted August 5, 2009 Now those examples make perfect sense. Supraglottic airways are not going to work on subglottic obstructions. And it may indeed turn out that not only is ETI beneficial for these patients, but perhaps even RSI as well. And I doubt that anyone is advocating *not* attempting intubation in those patients. Now all we have to do is study it and get the proof. Re: Intubation dogpile Severe burn patients with airway swelling shut. The burns can be thermal or chemical. And there are other times such as anaphalaxis non responsive to the meds. Remember I am in rural areas and at times a long way to a hospital. Airway closes w/o tube you are not going to be able to ventilate. You are just going to watch the person die. And as I mentioned earlier this may not change the ultimate outcome but w/o them getting to the hospital alive they have 0% chance. Maybe my patient will be the +-1% and actually survive because they had airway secured. I do not want to say well studies say you will die anyway so we are just going to sit here and attempt to force air past you closed off airway, please quit struggling the studies say it doesn't matter anyway. And hey studies never make mistakes so so long. I don't know about you but if I get to them alive I want to be able to keep them alive to the hospital. I have had some die in the ambulance and I understand that is part of what we do. In fact I hate when people say no one dies in my ambulance, what a load of poop. I understand the studies say ultimately it seems not to change outcomes, well if we get them to the hospital alive we have changed outcome at least for a little while. I do agree maybe we should use a simple adjunct and if effective save the intubation for the controlled environment of the hospital. But not all patients can wait. Again no disrespect meant to you more experienced Paramedics than I am. No disrespect meant to anyone and I am not trying to argue, I just can not see the benefit of completely removing something that can benefit some patients even if in a very low percentile. Thanks for putting up with my worthless thoughts. Renny Spencer Paramedic > > I think you're missing his point, Renny. > > Which ones of your patients are the ones that will not make it the ER > alive without intubation? How do you know that they couldn't have done > as well with say, a King airway or an LMA? We've all had patients that > we're fairly certain would have done poorly without advanced airway > management. But who is to say that advanced airway management > necessitates an ET tube? > > I'm not going to trot out the tired " anecdote does not equal data " > argument, but Kenny has a point, one I think everyone is missing: > > We intubate a lot of people. Thus far, we have a number of studies that > show that a few services excel at the skill, and a great many more suck > at it, but we have ZERO studies that show even a correctly placed tube > improves outcomes. And until we have *data* and not *anecdote* that > shows a demonstrable benefit, for however small a subset of patients, we > need to be a lot more judicious in who and how often we tube. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 5, 2009 Report Share Posted August 5, 2009 Thanks and sorry I was not being clear on my earlier posts. We do not need to keep doing things because of tradition, because we always have done it this way. We do need fact, scientific based methods. So I agree maybe we need to re-look at when we choose to intubate, but I can not agree with any that suggest it be taken completely out of our medical kits. > > > > > > I think you're missing his point, Renny. > > > > > > Which ones of your patients are the ones that will not make it the ER > > > alive without intubation? How do you know that they couldn't have done > > > as well with say, a King airway or an LMA? We've all had patients that > > > we're fairly certain would have done poorly without advanced airway > > > management. But who is to say that advanced airway management > > > necessitates an ET tube? > > > > > > I'm not going to trot out the tired " anecdote does not equal data " > > > argument, but Kenny has a point, one I think everyone is missing: > > > > > > We intubate a lot of people. Thus far, we have a number of studies that > > > show that a few services excel at the skill, and a great many more suck > > > at it, but we have ZERO studies that show even a correctly placed tube > > > improves outcomes. And until we have *data* and not *anecdote* that > > > shows a demonstrable benefit, for however small a subset of patients, we > > > need to be a lot more judicious in who and how often we tube. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 5, 2009 Report Share Posted August 5, 2009 Thanks and sorry I was not being clear on my earlier posts. We do not need to keep doing things because of tradition, because we always have done it this way. We do need fact, scientific based methods. So I agree maybe we need to re-look at when we choose to intubate, but I can not agree with any that suggest it be taken completely out of our medical kits. > > > > > > I think you're missing his point, Renny. > > > > > > Which ones of your patients are the ones that will not make it the ER > > > alive without intubation? How do you know that they couldn't have done > > > as well with say, a King airway or an LMA? We've all had patients that > > > we're fairly certain would have done poorly without advanced airway > > > management. But who is to say that advanced airway management > > > necessitates an ET tube? > > > > > > I'm not going to trot out the tired " anecdote does not equal data " > > > argument, but Kenny has a point, one I think everyone is missing: > > > > > > We intubate a lot of people. Thus far, we have a number of studies that > > > show that a few services excel at the skill, and a great many more suck > > > at it, but we have ZERO studies that show even a correctly placed tube > > > improves outcomes. And until we have *data* and not *anecdote* that > > > shows a demonstrable benefit, for however small a subset of patients, we > > > need to be a lot more judicious in who and how often we tube. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 5, 2009 Report Share Posted August 5, 2009 Kenny, Kenny, Kenny, In two emails you have talked about what a fine paramedic Lee is (which is true). But have you seen his head? Do you really want to make it larger than it already is? I mean, poor guy..it's just mean to do that to him! I imagine he has enough trouble with it as it is! Lee...... Love you brother! And what would the studies say about all that crazy stuff we did 20-odd years ago that " seemed " to save some folks? I shudder to think... Moseley, LP On Tue, Aug 4, 2009 at 7:18 PM, Kenny Navarro < kenneth.navarro@...> wrote: > > > spenair wrote: >>> So you mean all that stuff I learned in school will work > if I apply it? <<< > > It depends on how you define " work " . If you mean successfully accomplish > the skill, the answer is yes. By maintaining skill competency and utilizing > meticulous performance methodology, you can successfully accomplish the > skills. > > If " work " means to improve patient outcomes, then the jury is still out on > that one. > > >>> I hate the knee jerk reactions we see. <<< > > You mean like assuming that all EMS practices work because Lee can > successfully perform a nasal intubation. Lee is a fine paramedic, If I ever > need to be intubated, I would be proud to have him ventilate me with a BVM. > > Almost every scientific paper I have read for the past twenty years > questions the efficacy of ETI in the prehospital environment. After that > much time and energy, asking someone to step up and start protecting > patients hardly seems like a knee jerk reaction. > > >>> Instead of removing it from those that follow good practice, causing > patients that would benefit from it to suffer . . . . . . <<< > > I will assume you mean endotracheal intubation. The problem with your > statement is that no one has identified (scientifically) the subgroup of > patients who may benefit from ETI in the field. We already know the ones who > are not benefiting and those being harmed. > > Kenny Navarro > Dallas > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 5, 2009 Report Share Posted August 5, 2009 Kenny, Kenny, Kenny, In two emails you have talked about what a fine paramedic Lee is (which is true). But have you seen his head? Do you really want to make it larger than it already is? I mean, poor guy..it's just mean to do that to him! I imagine he has enough trouble with it as it is! Lee...... Love you brother! And what would the studies say about all that crazy stuff we did 20-odd years ago that " seemed " to save some folks? I shudder to think... Moseley, LP On Tue, Aug 4, 2009 at 7:18 PM, Kenny Navarro < kenneth.navarro@...> wrote: > > > spenair wrote: >>> So you mean all that stuff I learned in school will work > if I apply it? <<< > > It depends on how you define " work " . If you mean successfully accomplish > the skill, the answer is yes. By maintaining skill competency and utilizing > meticulous performance methodology, you can successfully accomplish the > skills. > > If " work " means to improve patient outcomes, then the jury is still out on > that one. > > >>> I hate the knee jerk reactions we see. <<< > > You mean like assuming that all EMS practices work because Lee can > successfully perform a nasal intubation. Lee is a fine paramedic, If I ever > need to be intubated, I would be proud to have him ventilate me with a BVM. > > Almost every scientific paper I have read for the past twenty years > questions the efficacy of ETI in the prehospital environment. After that > much time and energy, asking someone to step up and start protecting > patients hardly seems like a knee jerk reaction. > > >>> Instead of removing it from those that follow good practice, causing > patients that would benefit from it to suffer . . . . . . <<< > > I will assume you mean endotracheal intubation. The problem with your > statement is that no one has identified (scientifically) the subgroup of > patients who may benefit from ETI in the field. We already know the ones who > are not benefiting and those being harmed. > > Kenny Navarro > Dallas > > > Quote Link to comment Share on other sites More sharing options...
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