Hi Paul,
Correct. Given the alternative of nothing or an OP airway in carers with BLS skils, would still support an LMA.
RSI in an entrapped patient sitting upright is somewhat fraught.
Agree that Ketamine very useful drug in these situations.
Anton
In message <407A7F04.000006.03192@DR-8WA8AC4B0ZXI> Paul Middleton <[log in to unmask]> writes:
>
> --------------Boundary-00=_8V22WCW0000000000000
> Content-Type: Text/Plain;
> charset="iso-8859-1"
> Content-Transfer-Encoding: quoted-printable
>
> Now I'm certainly confused. I assumed that the discussion was not what wa=
> s
> the most appropriate modality for definitive airway maintenance in trauma
> per se, but what was appropriate for the maintenance of an imminently
> threatened airway by a responder without advanced airway skills. Although
> the LMA may be a device to "pipe vomit straight into the trachea" in the
> worst of circumstances, the question surely has to be what is a better
> choice as a temporary measure for the responder without the necessary
> advanced airway skills, in a patient where the patient is not maintaining
> their airway at all? Is it worse than a Guedel? Would you prefer airway
> opening manoeuvres alone? If the right person who is there is able to use
> ketamine and / or perform an RSI then this discussion is largely academic=
> ,
> however I believed this thread was about how airway maintenance is perfor=
> med
> in the absence of such skills.=0D
> Best wishes=0D
> Paul Middleton=0D
> Sydney Aeromedical Retrieval Service, Australia=0D
> =0D
> From: Accident and Emergency Academic List=0D
> Date: 04/12/04 19:11:29=0D
> To: [log in to unmask]
> Subject: Re: Airway technique??=0D
> =0D
> I am getting mixed messages now. On the one hand anton is saying that it =
> is
> rare for Fire to be on=0D
> scene first, and on the other that he expects them to be deploying invasi=
> ve
> airway techniques in=0D
> (presumably) sitting (presumably) trapped patients, which are extremely
> unwise in that situation.=0D
> Even with years of anaesthetic training I think very hard before putting
> anything in an upper airway=0D
> on a patient whose airway is difficult to access, and I still tend to hav=
> e a
> very light touch and use=0D
> ketamine for preference rather than trying to intubate - although of cour=
> se
> there are situations=0D
> where you have to secure an airway - severe facial bleeding for example a=
> nd
> you have to do a=0D
> proper RSI. We have rehearsed the argument about LMAs in trauma here befo=
> re,
> and I still stand=0D
> by my original comments that they are completely inappropriate as they
> simply pipe vomit straight=0D
> into the trachea.=0D
> =0D
> The situation is entirely different from a cardiac arrest in a ward
> environment (I'm thinking of Peter=0D
> Baskett and Brian Stone's paper) and I am now very uneasy.=0D
> =0D
> =0D
> > ----- Original Message -----=0D
> > From: "Rowley Cottingham" <[log in to unmask]>=0D
> > To: "Martyn Hodson" <[log in to unmask]>=0D
> > Sent: Sunday, April 11, 2004 10:11 AM=0D
> > Subject: Re: Airway technique??=0D
> =0D
> >=0D
> > depends on how you define 'basic life support skills'=0D
> >=0D
> > under previous definitions everyone up to ALS providers, who used any=0D
> > equipment during resuscitation was undertaking 'BLS with Adjuncts' ,=0D
> > however=0D
> > the rise of 'ILS' as a concept has muddied the waters.=0D
> >=0D
> > i think Anton is speaking of providers with educational profiles=0D
> > equivalent=0D
> > to ambulance technician, rather than lay people=0D
> >=0D
> > Martyn=0D
> >=0D
> >=0D
> > ---=0D
> >=0D
> =0D
> Best wishes,=0D
> =0D
> =0D
> Rowley Cottingham=0D
> =0D
> [log in to unmask]
> Visit the new and improved http://www.emergencyunit.com=0D
> =20
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> <TD id=3DINCREDITEXTREGION style=3D"FONT-SIZE: 12pt; CURSOR: auto; FONT-F=
> AMILY: Arial" width=3D"100%">
> <DIV>Now I'm certainly confused. I assumed that the discussion was n=
> ot what was the most appropriate modality for definitive airway maintenan=
> ce in trauma per se, but what was appropriate for the maintenance of an i=
> mminently threatened airway by a responder without advanced airway skills=
> =2E Although the LMA may be a device to "pipe vomit straight into the tra=
> chea" in the worst of circumstances, the question surely has to be what i=
> s a better choice <EM>as a temporary measure </EM>for the responder witho=
> ut the necessary advanced airway skills, in a patient where the patient i=
> s not maintaining their airway at all? Is it worse than a Guedel? Would y=
> ou prefer airway opening manoeuvres alone? If the right person who is the=
> re is able to use ketamine and / or perform an RSI then this discussion i=
> s largely academic, however I believed this thread was about how airway m=
> aintenance is performed in the absence of such skills.</DIV>
> <DIV>Best wishes</DIV>
> <DIV>Paul Middleton</DIV>
> <DIV>Sydney Aeromedical Retrieval Service, Australia</DIV>
> <DIV> </DIV>
> <DIV id=3Dreceivestrings>
> <DIV dir=3Dltr style=3D"FONT-SIZE: 11pt" <i><B>From:</B></I> <A href=3D"m=
> ailto:[log in to unmask]">Accident and Emergency Academic List</A=
> ></DIV>
> <DIV dir=3Dltr style=3D"FONT-SIZE: 11pt" <i><B>Date:</B></I> 04/12/04 19:=
> 11:29</DIV>
> <DIV dir=3Dltr style=3D"FONT-SIZE: 11pt" <i><B>To:</B></I> <A href=3D"mai=
> lto:[log in to unmask]">[log in to unmask]</A></DIV>
> <DIV dir=3Dltr style=3D"FONT-SIZE: 11pt" <i><B>Subject:</B></I> Re: Airwa=
> y technique??</DIV></DIV>
> <DIV> </DIV>
> <DIV>I am getting mixed messages now. On the one hand anton is saying tha=
> t it is rare for Fire to be on</DIV>
> <DIV>scene first, and on the other that he expects them to be deploying i=
> nvasive airway techniques in</DIV>
> <DIV>(presumably) sitting (presumably) trapped patients, which are extrem=
> ely unwise in that situation.</DIV>
> <DIV>Even with years of anaesthetic training I think very hard before put=
> ting anything in an upper airway</DIV>
> <DIV>on a patient whose airway is difficult to access, and I still tend t=
> o have a very light touch and use</DIV>
> <DIV>ketamine for preference rather than trying to intubate - although of=
> course there are situations</DIV>
> <DIV>where you have to secure an airway - severe facial bleeding for exam=
> ple and you have to do a</DIV>
> <DIV>proper RSI. We have rehearsed the argument about LMAs in trauma here=
> before, and I still stand</DIV>
> <DIV>by my original comments that they are completely inappropriate as th=
> ey simply pipe vomit straight</DIV>
> <DIV>into the trachea.</DIV>
> <DIV> </DIV>
> <DIV>The situation is entirely different from a cardiac arrest in a ward =
> environment (I'm thinking of Peter</DIV>
> <DIV>Baskett and Brian Stone's paper) and I am now very uneasy.</DIV>
> <DIV> </DIV>
> <DIV> </DIV>
> <DIV>> ----- Original Message -----</DIV>
> <DIV>> From: "Rowley Cottingham" <<A href=3D"mailto:rowley@ROWLEYS-=
> HOST.COMPULINK.CO.UK">[log in to unmask]</A>></DIV>
> <DIV>> To: "Martyn Hodson" <<A href=3D"mailto:[log in to unmask]
> SERVE.CO.UK">[log in to unmask]</A>></DIV>
> <DIV>> Sent: Sunday, April 11, 2004 10:11 AM</DIV>
> <DIV>> Subject: Re: Airway technique??</DIV>
> <DIV> </DIV>
> <DIV>></DIV>
> <DIV>> depends on how you define 'basic life support skills'</DIV>
> <DIV>></DIV>
> <DIV>> under previous definitions everyone up to ALS providers, who us=
> ed any</DIV>
> <DIV>> equipment during resuscitation was undertaking 'BLS with Adjunc=
> ts' ,</DIV>
> <DIV>> however</DIV>
> <DIV>> the rise of 'ILS' as a concept has muddied the waters.</DIV>
> <DIV>></DIV>
> <DIV>> i think Anton is speaking of providers with educational profile=
> s</DIV>
> <DIV>> equivalent</DIV>
> <DIV>> to ambulance technician, rather than lay people</DIV>
> <DIV>></DIV>
> <DIV>> Martyn</DIV>
> <DIV>></DIV>
> <DIV>></DIV>
> <DIV>> ---</DIV>
> <DIV>></DIV>
> <DIV> </DIV>
> <DIV>Best wishes,</DIV>
> <DIV> </DIV>
> <DIV> </DIV>
> <DIV>Rowley Cottingham</DIV>
> <DIV> </DIV>
> <DIV><A href=3D"mailto:[log in to unmask]">[log in to unmask]</A></DIV>
> <DIV>Visit the new and improved <A href=3D"http://www.emergencyunit.com">=
> http://www.emergencyunit.com</A></DIV>
> <DIV> </DIV></TD></TR>
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