advanced airways

Advanced Airway Inservice

(1) Pig Trachea with scalpel and hemostat
(2) Needle Cricothyrotomy with 14g angiocath and 3.0 ETT hub
(3) Pertrach Kit
(4) Surgical Cricothyrotomy with 6.0 ETT

The anatomical landmarks of a pig’s trachea are similar to those of a human. These interventions are justifiably indicated for worse case scenarios only, but I’m so glad I had the opportunity to get some “outside of the book” training. Continuing education is vitally important for pre-hospital personnel. It not only refreshes my training, it also refreshes my attitude and respect for the work.

Endotracheal intubation

Endo - Prefixes indicating within, inner, absorbing, or containing

Tracheal - Anatomical area of the human body, the trachea. also called the windpipe.

You have a patient with a GCS of 7, their respirations are agonal and oxygen saturation is 84%. First rule for anyone in the medical field is to get oxygen back into the is person’s body and fast. One of the common ways in the field and the Emergency room are to place what they call an Endotracheal tube.

The cartilage in your neck, more predominant on men as the “Adams apple,” this is called the thyroid cartilage. It houses your vocal cords and is the immediate opening of the airway. When you look down into a patient’s throat, using a MAC or MIL blade, you will be looking for the epiglottis (the little flap that covers the airway when you swallow food. Then you’ll look for the vocal cords.

The ET tube will have to slide past this to be able to work properly. Once you are confident in your placement and have followed your steps to secure it, you will test it. Some people forget that to auscultate the stomach, listening for gurgling sounds is the first thing you do when pushing air. This means you put it in the esophagus and that is BAD! If that happens, You can pull back tube and try again.

Auscultation of lung sounds bilaterally will be important, to make sure you haven’t slipped the tube past the carina and into one of the bronchioles. Secure the airway and maintain. Remember to always document.

This is just a brief overview. I have place advanced airway techniques video under as a better reference. Remember though, airway is one of the top priorities in the medical field. Without air, it only takes about 4 minutes to cause severe brain damage.

Written by: Meddaily

Ugh

Today was thanksgiving. I worked a paramedic fly car. Thanksgiving was slow… Quiet even. Until 15:09 hours when I got a job to back up an EMT unit calling for a medic. It was a respiratory distress call. I won’t get into the medicine behind it because I don’t want to bore anyone but I had to intubate her. Intubation is an advanced level of airway management that is only performed by doctors and paramedics. This was an 87 year old female alone on thanksgiving. When I got there she was in bad shape. But I couldn’t help but notice all the pictures on her wall and family and her husband and loved ones. She seemed to have lived a full life. She was a nun for a period of time. She seemed like a good person who at one time had a life full of love and family. Today however she was alone on thanksgiving struggling to breath. The EMTs did all that they could and did the right thing by calling for a paramedic. I arrived and tried everything I possibly could to not intubate her. Nothing worked. So I had to sedate, paralyze and intubate her. And the last thing this woman saw was my face as she went unconscious from the medication I gave her to sedate her ready with a giant mac blade and ET tube to shove into her trachea. Shes alive right now and doing ok intubated in the ER… Still alone without family sedated and intubated with a machine breathing for her. What I’m trying to say is that life goes fast and tomorrow is never promised. Live well. Love hard. And be a good person.

#PARAMEDIC

It’s called research... do it

Reading and enjoying one of my romantic smutty books, then one of the characters has surgery and everything goes to hell. 

It was a knee replacement surgery and for some reason the character goes to the ICU after… they’re not still intubated or seemingly having any complications immediately after surgery. Confused. The character ends up developing a PE, the author describes what happens with a PE and gets it TOTALLY WRONG! It really bothered me, but I moved on. After going back to surgery for his PE (though first they emergently reintubate the patient without sedating him and having family members hold down the patient because he’s like convulsing… WTF? No!) Next the author totally misunderstands “life support”. Generally we don’t take people off machines that are ‘keeping the heart beating’… that’s a pacemaker, we don’t just turn those off and “see how you do” then defibrillate if the heart doesn’t start beating (that shit doesn’t work anyway). I highly doubt with the patient’s diagnosis they would be paced anyway. Nor do we just take them off the ventilator and hope for the best, there’s a process. We don’t take out the tube and THEN see if you can breathe on your own… we do that shit with the tube still in that way we can just switch the vent back to breathing for you. They were also supposedly worried about the guy’s brain function after this episode because he brain was ‘deprived of oxygen’… No, it really wasn’t. The guy was in the ICU and was forcibly intubated (according to the story) within a minute of throwing the PE and going into respiratory distress… unless even being intubated with the clot in he was still not pulling great SATs, but still he would maybe SAT in the 70-80s with that, his brain would’ve been fine… kidneys might suffer a little bit. After all this he’s randomly in a coma… for seemingly no medical reason. I’m going to place my bets on my old pal conversion disorder. The character had a big trauma in the past and undiagnosed/untreated PTSD.

I mean, do your fucking research people! Any fiction writers out there, if you have something medical in your story, run it by me first… PLEASE! I’ll be more than happy to the descriptions as real as possible and also understandable for the masses. This isn’t TV or movies, you are not confined by time constraints. Your characters don’t have to chill within seconds of receiving IV/IM ativan or haldol… that shit needs time to circulate and reach the proper receptors. The only shit that works that fast are paralytics and you can’t just go around shooting people without advanced airways (or about to receive one) with them willy nilly… they will stop being able to breathe on their own. 

Ok, I’m done… for now.

/rant