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
    Travis Jordan
    The Butler Did It
    Try CHAMPS (in a more logical order than SAMPLE) C - Chief Complaint H - History A - Allergies M - Medicines P - Previous Activity S - Signs/Symptoms (vitals)
    2015-02-26 03:01:09
    B Thompson
    AHA 2015 Guidelines: A Preview
    Whether you are excellent at intubation or not is irrelevant. I can drop an iGel airway with an NG tube in a patient and apply the vent before most people could finish prepping for an intubation. That is the goal. Less time securing an airway and more time focusing on compressions, drug therapy, and reversing…
    2015-02-24 23:54:11
    Levi Peterkin
    The Butler Did It
    Good day, I have trouble making a patient report to a triage nurse. Sometimes I don't know how to remember all the important stuff and summarize it effectively.
    2015-02-23 18:27:14
    Dawn
    Dopamine
    What are your thoughts on titrating a dopamine drip drop off? Do you go from 5 to 0? Or do you ease from 5 to 0? I have a theoretical answer in my head, I just would like another's perspective.
    2015-02-23 16:04:24
    BH
    AHA 2015 Guidelines: A Preview
    If medics can't intubate with CPR in progress they need to train until they can, or more correctly, can't miss. At my level of care we don't even intubate a live person before being licensed and I regularly intubate with a Lucas device running. It ain't rocket science.
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