In article <[log in to unmask]>, Erich
Schulz <[log in to unmask]> writes
>Hi Javed,
>
>picking on the airway management aspect only of your story
>
>>Would you intubate ?
>definitely - if you've done it before and you've got the kit - IMHO its far
>easier to ventilate somebody reliably with a tracheal tube - mask
LMA (Laryngeal Mask Airways) are an alternative to Tracheal Tubes
>ventilating an toothless patient can tax even anaethetists.
>
>In a patient in poor condition that you're unsure will benefit from CPR I
>would still intubate if had decided to do cardiac massage - I think a short
>sharp burst (20 minutes) of advanced life support is better than half an
>hour of less aggressive resuscitation - getting an accurate time of
>collapse and time of commencement of resuscitation deciding when to cease.
>(I always forgot to look at my watch)
>
>>Is Cord Transection that much of a risk that it should not be attempted
>> except in a hospital scenario ?
>Cord Transection is really only a risk for patients with rheumatoid
>arthritis. *far* greater risk is oesophageal intubation - this can be
>harder to spot than you'd imagine and reasonably likely if you're rusty -
>try to watch the tip of the tube pass through the vocal cords and listen in
>*both* axilla for breath sounds - *any* doubt = extubate and reconsider
>airway options
>
>>Would you have done things differently?
>Out of hospital arrest has abysmal prognosis - don't know what others think
>but sounds like you gave excellent care given the situation.
>
>Only knit-picking comment I'd make is on the IV access. In a patient in VF
>administering the first 3 shocks has a very high priority and I'd do this
>first before thinking about IV access. Once you've got an tracheal tube in
>the only drug you can't administer down that is bicarbonate. In a GP
How many know the altered doses for per tracheal administration?
a suitable alternate route is via the base of the tongue in the absence
of proper IV access
>waiting room a IV cannula could be more distracting than helpful -
>reasonable to put in if you've got a fourth set of hands (first on airway,
>second on cardiac massage, third on drugs & rhythm & def-fib, fourth on IV
>access?)
>
>best wishes
>Erich
>
>(who obviously misses his anaesthetic SHO day more than he realised)
who still adminsters Dental Anesthetics at dental surgeries (& enjoys
it)
--
David J Brown
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