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!

1 Trackback

Leave a Reply

Your email address will not be published. Required fields are marked *

background image Blogger Img

Peter Canning

JEMS Talk: Google Hangout

Recent Posts
SW_Rectangle The Jug March 26, 2015
SW_Rectangle The Ideal Medic March 24, 2015
The Butler Did It February 19, 2015
Medicscribe_Header Gifts January 25, 2015
Categories
  • ems-health-safety (7)
  • ems-topics (702)
  • hazmat (1)
  • Uncategorized (420)
  • Comments
    Ihunanya udochu
    AHA 2015 Guidelines: A Preview
    Airway protection is important in a cardiac arrest patient especially endotracheal intubation unlike supraglottic airway which does not and there is risk of aspiration.A paramedic should learn how to intubate the trachea, pass an LMA and NG tube. Protecting the airway shouldn't be enough, paramedics should know how to position his hands, and also the…
    2015-04-07 15:56:27
    medicscribe
    No Chest Compressions
    You can't do CPR without chest compressions. If you don't do chest compressions it is not CPR. The patient's heart has stopped. Aside from opening their chest and doing cardiac massage, there is no way to make the heart pump without doing chest compressions. Chest compressions are by nature traumatic. Ribs are often broken by…
    2015-04-01 21:24:02
    Anonymous
    No Chest Compressions
    Actually, as a decision maker for an individual with osteoporosis I am facing this dilemma now. Guidance in our state's code suggests that I do not consent to a DNR unless there is a compelling reason - such as terminal illness. However, I am aware that manual CPR would be devastating to the body of…
    2015-04-01 20:57:01
    Mike
    You Don't Have to Put on Your Red Lights
    I totally understand what you guys are saying and how you feel. It's a shame that because there are bad apples in a basket, we as people think the whole basket is bad and this is so far from the truth. I was an EMT for a little while, it was my part time job…
    2015-03-29 15:05:53
    Sandy
    The Ideal Medic
    As a 24 year medic, I finally figured out it wasn't me. Thank you for your article. You can't teach that in any classroom. I have always found that empathy is a great tool. Use it to benefit the patient and teach others what it is all about.
    2015-03-24 22:24:30

    Now Available: Mortal Men

    Mortal Men is available as an electronic book for Kindle, Nook or any other e-reader. Here is a link to some of the places to buy it. The book sells for $3.99. Barnes and Noble Amazon Smashwords Scribd Also Available from iBooks

    Order My Books

    Support EMS Bloggers, Buy Their Books

    Google

    Order Books and Movies

    FireEMS Blogs eNewsletter

    Sign-up to receive our free monthly eNewsletter

    LATEST EMS NEWS

    HOT FORUM DISCUSSIONS