Every day, hundreds of thousands of patients seek treatment at the emergency department and between 10 and 12 percent of those patients arrives by ambulance. Of those, only a few present with life threatening emergencies that result in either immediate or eventual endotracheal intubation. This is not to say that intubation is an unimportant skill, quite the contrary. Without a patent airway, most humans will succumb to anoxia in 4-6 minutes. Why then, has pre-hospital endotracheal intubation become so controversial?
In the 1850’s, doctors developed methods to view the vocal cords of live patients and subsequently intubate the trachea with a metal tube. Prior to those developments, securing a patient’s airway involved surgical techniques such as the tracheotomy, a procedure dating back as early as 3600 BC (1). Since that time, several advancements have been made including better techniques, improved laryngoscope blade design, and more recently, video laryngoscopy. Each improvement should foster better performance yet medical professionals continue to struggle with this skill.
Over forty years ago, in large part to Accidental Death and Disability: The Neglected Disease of Modern Society, the role of the paramedic was created. This publication, also known as ‘The White Paper’, documented the lack of training and standardization in the field of public safety. “This standardization led to the first nationally recognized curriculum for EMS - Emergency Medical Technician–Ambulance (EMT-A) - which was published in 1969. Many consider this document to be the birth of modern EMS” (2). Several years later, because of the belief that more could be done in the field of pre-hospital emergency care, the paramedic curriculum was bo...
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...ientific evidence against prehospital ETI that is driving it out of EMS practice. It's simply the inability to properly educate students in use of the [endotracheal] airway. Although mannequin practice and human simulation are improving, there remains a need to learn this skill on human subjects” (6).
If prehospital endotracheal intubation is to remain a viable skill, paramedics must learn, practice, and maintain a proficiency in this rarely used but highly valuable skill. Certainly, alternative airways are a viable answer but there are still situations where the endotracheal tube will remain superior. “A survey of paramedics ranked ETI as the [skill] highest in importance. Thus, attempts to limit or remove this skill is [sic] often met with an emotional response” (6). Paramedics must remain objective and embrace positive change for our profession to thrive.
Turk, Sarah. "Ambulance Services in the US." IBISWorld. N.p., Oct. 2013. Web. 7 Mar. 2014.
This essay describes how the anaesthetic machine and airway management equipment are prepared in operating theatres and discusses how they are ensured safe for use. It evaluates the Association of Anaesthetists of Great Britain and Ireland (AAGBI) guidelines related to safe practice and the preparation of the ET tubes, laryngeal masks, guedels, Naso pharyngeal airways and the laryngoscope. The function of the anaesthetic workstation is to deliver a mixture of anaesthetic agents and gases safely to the patient during the induction process and throughout surgery. In addition, it also provides ventilation to support breathing and monitors the patient’s vital signs to minimise the anaesthetic risks to the patient whilst in the care of health professionals. The pre-use check is vital to patient safety as an inadequate check of the anaesthetic machine or airway management equipment can and does lead to significant harm of the patient including mortality (Medicines and Healthcare Products Regulatory Agency (MHRA), 2008 and Magee, 2012).
Duerden, M. & Price, D. (2001). Training issues in the use of inhalers. Practical Disease
Which brings about the question as to just how effective is simulation training? According to Kneebone, Nestel, Vincent, & Darzer (2007), “To be effective, however, such simulation must be realistic, patient-focused, structured, and grounded in an authentic clinical context. The author finds the challenge comes not only from technical difficulty but, also from the need for interpersonal skills and professionalism within clinical encounters” (p. 808). Most mannequins do not have vocal ability or the ability to move, and therefore cannot provide the proper a spontaneous environment for learning. Therefore, acquiring critical thinking skills can be somewhat challenging, in this type of simulated setting.
Williams, B, Jennings, P, Fiedler, C & Ghirardello, A 2013, ‘Next generation paramedics, agents of change, or time for curricula renewal?’, Advances in Medical Education & Practice, vol.4, pp. 225, doi: http://dx.doi.org/10.2147/AMEP.S53085
American Association of Nurse Anesthetists. Professional Aspects of Nurse Anesthesia Practice. Philadelphia: F. A. Davis Company, 1994. Print.
“Summary Report for: 29-2041.00 - Emergency Medical Technicians and Paramedic.” O*Net. 2008. Web. 18 Feb. 2010.
Medical technology today has achieved remarkable feats in prolonging the lives of human beings. Respirators can support a patient's failin...
The larynx prevents food and liquids from traveling down the air path ways which could result in choking. From the larynx, Bronchi trachea splits into two bronchi each leading to a lung, each lung is divided into lobes. The right lung has three lobes and the left has two lobes. The right lung is slightly larger than the left lung. The two lungs are mainly made of up connective tissue, which gives them their soft and spongy texture. The bronchi branch are smaller and are called bronchioles which are divided many more times in the lungs. The lungs is made up of connective tissue, blood, lymphatic tissue, air pathways and alveoli are at the end of the branches inside of the lungs. The alveoli sends oxygen and removes carbon dioxide. This is a basic view of how the respiratory system functions and if the respiratory system doesn’t do its job then this could lead to infectious diseases of the respiratory
Halie Robinson Mrs. Ehle Honors English 8 11 March 2014 Exploring Nurse Anesthesia Purpose When I was younger, I always wanted to pursue a medical career. Whether it was helping humans or animals, I always wanted to save lives. To this day, I want to have a career in medicine, but I did not have a specific job in mind until recently. My mom was the one who introduced me to the idea of becoming a nurse anesthetist.
VAP develops in a patient after 48 hours or more of endotracheal intubation. According to a study by Relio et al. (as citied in Fields, L.B., 2008, Journal of Neuroscience Nursing, 40(5), 291-8) VAP adds an additional cost of $29,000-$40,000 per patient and increases the morality rate by 40-80%. Mechanically ventilated patients are at an increased risk in developing VAP due to factors such as circumvention of body’s own natural defense mechanisms in the upper respiratory tract (the filtering and protective properties of nasal mucosa and cilia), dry open mouth, and aspiration of oral secretions, altered consciousness, immobility, and possible immunosuppression. Furthermore, the accumulation of plaque in the oral cavity creates a biofilm that allows the patient’s mouth to become colonized with bacteria.
On the 7th of March in 2018, I attended the Community experience with the EMS team at Fire station of area one. This station is located at the northeastern corner of nine mile road. Upon arrival I introduce myself to the team. Every member of the team was presented in a professional manner that included: one’s skills, education, and the years of experience. During the meeting, several subjects were discussed such as: nursing student’s objective from this experience, Clarifying tasks and tactics, protocols and daily operations. All the tasks were executed with each member of the team with integrity, honesty and beneficence to the warren community. During the twelve hours shift, there
Working in the emergency department can be easily described as fast placed and at times hectic. Being aware of resource management and learning to prioritize patients are skills that are required to be learned quickly. Once a basic understanding and knowledge of these skills are acquired, nurses are able to build off of them and adapt them however they see fit.
Monnet et al(1) published a review article on assessment of volume responsiveness in mechanically ventilated patients using heart and lung interactions. He explained that mechanical ventilation produces cyclic changes left ventricular stroke volume due to inspiration and expiration induced changes in LV preload. It denotes preload dependency of left ventricle indirectly right ventricle. He also describes various limitations of respiration variations in SV for predicting fluid responsiveness.
In a pre-hospital setting, there are few moments that are as intense as the events that take place when trying to save a life. Family presence during these resuscitation efforts has become an important and controversial issue in health care settings. Family presence during cardiopulmonary resuscitation (CPR) is a relatively new issue in healthcare. Before the advent of modern medicine, family members were often present at the deathbed of their loved ones. A dying person’s last moments were most often controlled by his or her family in the home rather than by medical personnel (Trueman, History of Medicine). Today, families are demanding permission to witness resuscitation events. Members of the emergency medical services are split on this issue, noting benefits but also potentially negative consequences to family presence during resuscitation efforts.