I think the problem over here is one of safety first.
Sure it's easy to learn how to do an RSI. It's when
you run into trouble that the problem arises. I did
hundreds and hundreds when I was an anaesthetist, but
it took me a little longer than 2 days to learn how to
do them safely and competently - also a lot of
practice.
but again the theory is easy enough.
Cautionary tale..the other day in a/e, head injured
guy rapidly falling coma scale..good indications for
intubation and then a scan. RSI.....by me...happy and
very confident in my skills..bingo grade 3 intubation
time. No physical signs that he might be either. It
was only after a lot of fiddling with introducers and
eventually a gum elastic bougie that the tube went
down at all. Sometimes you just cant tell who is going
to be difficult until you're there and then - like all
skills - your experience determines the outcome, and
your support staff, and the equipment you have. It was
hard enough in a well lighted A'E dept. I've tubed
guys on the road and I just know that this guy would
have been even more difficult in that situation. Most
of the other interventions that we currently practice
are unlikely to kill you. RSI WILL if it goes wrong or
complications occur. That said I'm all in favour of
paramedics and basics guys doing it - providing they
do it at least 2 or 3 times a month and if that means
going into theatre then so be it. Remember also the
criteria of patients you are talking about are
anaesthetists nightmares, multiple injuries, unstable
head injuries, no past medical history to hand, no
anaesthetic history to hand, unfasted, sometimes blood
in the oropharynx, suboptimal lighting and
monitoring.....etc. I could go on and on about this.
Also, how many ambulances currently carry ventilators.
How many Basics guys carry a capnograph ? Can you
really hear all 4 corners and the stomach well when
there are 3 fire appliances and a wee dog running
around in the background.
__________________________________________________
Do You Yahoo!?
Send instant messages & get email alerts with Yahoo! Messenger.
http://im.yahoo.com/
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
|