I received this mail from the CPR-AED list when I asked about prehospital
RSI in the US.
It doesn't avoid RSI but is am interesting way of managing difficult
intubations (especially if inline immobalisation reduces the view of the
cords).
Robbie Coull
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>From: [log in to unmask] (Eugene Fields)
>To: "Robert Coull" <[log in to unmask]>
>Subject: Re: Retrograde Intubation
>Date: Wed, Jan 6, 1999, 3:02 pm
>
>Retrograde intubation is a new addition to our protocol (since 1996) which
>has been very successful - almost idiot proof !!!
>
>1. An 18 ga. needle is inserted following the usual sterile procedure
>employed in a crichothyroidotomy procedure with the exception that once one
>is sure they are in the trachea (aspiration of air) the needle is oriented
>toward the head.
>
>2. A guidewire is passed through the needle and retrieved when it appears
>in the oropharynx and brought out through the mouth of the victim.
>
>3. Remove the needle. Place a hemostat on the wire/HOLD THE WIRE TIGHTLY
>(at the neck).
>
>4. Run the wire through the ET Tube and using the wire as a guide, slowly
>pass the ET tube into the trachea.
>
>5. When the tube reaches the puncture site at the neck, resistance is felt.
>
>6. Remove the wire slowly and carefully through the top of the tube to
>decrease the trauma to soft tissue of the neck.
>
>7. Attempt to ventilate - assure tube placement.
>
>8. Secure tube in the usual and acceptable fashion.
>
>Hope this helps !!
>
>E. M. Fields RN, CCRN, CEN, EMT-P
>Clinical Resource Nurse/Critical Care
>Lake Hospitals System Inc. Ohio
>
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