9. Alternative Airways

My List of the 16 Most Significant EMS Treatment Changes in My 20 Years as a Paramedic

9. Alternative Airways

When I started as a paramedic – all we had was the ET tube. You brought in a code, the first question you were asked in the EMS room was “Did you get the tube?” If you got the tube, you got an approving nod. You didn’t, after you left, the other medics would shake their head. Of course, if you got the tube, nobody asked how many tries it took you to get the tube. You might hear the medic’s EMT partner later commenting it was a “hard tube,” which meant there were multiple tries. Familiar with the term “A Pass the Larengyscope Code?” I have been at a few of those and heard of many more.

Nowdays, we have alternative airways – The LMA and the Combi-tube. We may soon get the King LT. And we have limits on the number of times a paramedic or any combination of paramedics can attempt an ET.  Two tries for the first medic and one for the second.  No more than three tries total.  And, most importantly, you don’t have to try at all.  You can just go to the alternative airway to start if you think it gives you the best chance to quickly secure the airway.

Here are some old posts describing my first LMA and my first Combi-tube, as well as a post called “The Battle” describing my beginning mindset when contemplating what airway to use.

LMA

Combi-tube

The Battle

I can tell you this now, based on the medical literature, and on my experiences with the LMA and Combi-tube, I no longer hesitate to use an alternative airway as my first line airway.

The goal is not to impress other medics, but to effectively ventilate the patient, and in cases of cardiac arrest, not to interrupt compressions. I can do both of those quite well with an alternative airway.

16 Most Significant EMS Treatment Changes in My 20 Years as a Paramedic

10. Chemical Restraint
11. No More Lasix
12. EZ-IO
13. Permissive Hypotension
14.Expanded Medication Routes, Less IV Emphasis
15. Narrower Use of Narcan
16. Increased Standing Orders

1 Comment

  • Eleanor says:

    Heya I really like your blog, particularly your latest stuff comparing what’s changed between now and 20 years ago as a paramedic. I run a blog on Emergency Services called http://www.helloemergency.co.uk I’d be really interested in getting a guest post from you on your experiences as a paramedic. It would have to be before the 7th of May though. Anyway please let me know if this is possible, email me and we can have a chat!

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Peter Canning

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  • Comments
    Josh
    EMS Drugs
    Great list. I was surprised to see Fentanyl left off the list since it seems to have become the go to prehospital analgesic over Morphine. I have been in EMS for 7 years and a medic for about a year and have seen/given Fentanyl far more often than Morphine for pain.
    2014-12-20 10:58:42
    EMS Artifact
    STEMI Call
    Medical calls are just far more interesting and challenging than trauma calls. I've heard of, but never seen anyone use Cabrera format. It certainly can throw you off if you're not looking very carefully. As to the rest of the call, sometimes nothing seems to go right. You did your job, you're not responsible for…
    2014-12-03 23:27:43
    Jordan Collins
    Morphine
    I know this is from a while ago but I like reviewing your drug rankings. I have found, even in the 10-15mg range, Morphine has little effect on pain. I would estimate maybe 1 in 5 patients feels any sort of pain relief. It's frustrating not getting people their relief, while jumping through all of…
    2014-12-02 22:46:44
    Karim
    STEMI Call
    Patients make liars out of paramedics! And yeah, sometimes the cath lab nurses are so mean.
    2014-11-29 15:17:55
    Dan
    STEMI Call
    Initially I thought my eyes were deceiving me while reading the ECG until I figured it out. I've run similar atypical STEMIs. Good job! Interesting blog!
    2014-11-26 20:52:20

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