Benefits vs. the risks of rapid sequence intubation in the pre-hospital environment:
Rapid sequence intubation is a very risky procedure even in a stable environment, but when the unknown variables in the pre-hospital environment are considered, this procedure becomes more criticized every time it is used. When initiating the rapid sequence intubation protocol, the paramedic takes total control over the patient’s airway. When evaluating the risks versus the benefits of an endotracheal tube insertion in the pre-hospital environment, paramedics must make split second decisions since the patient’s life depends on the paramedic’s knowledge and skills. If the paramedic’s attempt to intubate was unsuccessful, then he or she must be able to devise
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There have been several agencies in North Carolina, including Stanly County EMS, whom have abandoned this risky procedure due to the liability and effectiveness in the pre-hospital environment. Primarily, the main reason for the heightened criticism of Rapid sequence intubations stems from inadequately pre-oxygenating the patient before intubation. “Studies have shown that if the patient’s oxygen saturation in their blood is not above 90%, then the patient’s oxygen levels will start to tank when the paramedic starts the intubation procedure” (Davis et al). On the other hand, even if the patient has been pre-oxygenated before the paramedic starts the intubation, the paramedic could have a hard time sticking the endotracheal tube into the patient’s trachea. Since the patient cannot breathe on his or her own since they were paralyzed with potent drugs, the paramedic has just caused the patient’s brain to become depleted of oxygen. This turn of events could prove fatal for the patient. Another grave risk associated with rapid sequence intubations is that the patient’s blood pressure and heart rate could crash on the paramedic if the endoscope blade would happen to hit the vagus nerve in the back of the throat. In theory, if the patient is hypotensive, then the paramedic should avoid rapid sequence intubations, but if the paramedic had already started the procedure, he or she …show more content…
Usually, etomidate is the sedative of choice, followed by succinylcholine as the paralytic. These narcotics will be used to make it easier for the paramedic to gain access of the patient’s respiratory drive. Other drugs can be used to substitute or in addition to etomidate and succinylcholine. Midazolam can be used in place of etomidate if it is not available. Likewise, rocuronium can be substituted for succinylcholine if it is not available. While performing a rapid sequence intubation, the paramedic must assure he or she has the right dosage for the drugs of choice in the intubation. “In a six-year testing period, midazolam was shown to cause hypotension in patients because the drug was under dosed on many occasions” (Swanson et al). Throughout many different studies, doctors chose etomidate over midazolam because etomidate was the most hemodynamically stable drug between the two sedatives. “The study also concluded that etomidate could also decrease intracranial pressure within the skull” (Swanson et al). Etomidate has been studied for many years resulting in an abundance of knowledge about that specific drug, but Midazolam has not been through the testing that etomidate has. Even though there is not much scientific evidence supporting the usage of midazolam as a substitute for etomidate, midazolam is still considered the go-to drug when etomidate is not
Prior to intubation for a surgical procedure, the anesthesiologist administered a single dose of the neuromuscular blocking agent, succinylcholine, to a 23-year-old female to provide muscular relaxation during surgery and to facilitate the insertion of the endotracheal tube. Following this, the inhalation anesthetic was administered and the surgical procedure completed.
“Technological advancements in anesthesia practice: Role of decision support system.” Anesthesia: Essays and Researches. January 8, 2014. Web. October 23, 2015. There have been many advancements in technology in the anesthesia field. A recent major advancement has been the decision support system (DSS). The decision support system acts similar to a second human central nervous system, and receives as well as relays information to and from the patient and the anesthesia information management system (AIMS). The DSS helps to maintain the data coming into and out of the patient during a medical procedure. The DSS also provides help during a medical crisis, giving the physicians a solution if an intra-operation (during the operation) crisis happens. The DSS can also design various scenarios for pre, intra, and post operation scenarios for the anesthesiologist to prepare for based on that patient’s medical history, information, and
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).
It is not uncommon for a patient to experience pain and anxiety before or after a major procedure or breathing treatment. Imagining the myriad of complications that might occur during an operation can send one into multiple panic attacks. Coping with the loss of mobility and independence joined by the pain that accompanies recovery are only a few examples of the complex and traumatic experiences awaiting pre/post-operation patients. Fortunately, a medication was synthesized by Armin Walser and Rodney I. Fryer in 1975 to aid patients by easing anxiety and promoting sleepiness before an operation. An added benefit was that the events experienced during the operation were also forgotten while the medication was still in effect.
IV sedation is reserved for our most complicated procedures and patients with very high levels of fear and anxiety. IV sedation creates a sleep-like state that allows you to wake up from a procedure with no memory of the sights, smells, sounds, or sensations that occurred during the treatment. This form of sedation is administered through an intravenous line and only by a licensed
During clinical this week, the student nurse had the opportunity of an observational experience in a Specialty Care Unit. The student was directed to the Surgical Intensive Care Unit (SICU) to observe a patient that was critically ill and receiving extensive treatment. The student observed a nurse caring for a patient while administering therapeutic hypothermia after cardiac arrest. The patient L.E. is a 73 year old male. The patient has no history of coronary artery disease or any problems with his heart.
Hammer, L., Vitrat, F., Savary, D., Debaty, G., Santre, C., Durand, M., et al. (2009). Immediate prehospital hypothermia protocol in comatose survivors of out-of-hospital cardiac arrest. American Journal of Emergency Medicine, 27(5), 570-573.
American Association of Nurse Anesthetists. Professional Aspects of Nurse Anesthesia Practice. Philadelphia: F. A. Davis Company, 1994. Print.
Like with anything else, it is imperative to ensure a patent airway, adequate ventilation, good oxygenation, and adequate circulation. However, stroke patients have an increased risk of losing the ability to protect their own airway and subsequently aspirate. You can help protect the patient from aspirating by simply placing them in the semi-fowlers position. Now if severe vomiting becomes a factor and the airway is compromised, intubation may need to be used to protect the patient from any further aspiration. If either the tidal volume or rate becomes inadequate, quickly assist their ventilations at a rate of 10-12 breaths per minute. If assistance is needed with ventilations, its good practice to have your BVM hooked up to oxygen too because unless your patient is intubated at this point, some of the room air you pump into them is going to go into the stomach, making for less adequate oxygenation. Along with the ABC component, you’re going to establish IV access and apply the cardiac monitor to see what the heart is doing (Mistovich, 2008). Treating the symptoms is all you’re going to be able to do. As it was mentioned before, the only way to treat the underlying problem is to get the patient to the hospital as quickly as you
Medical technology today has achieved remarkable feats in prolonging the lives of human beings. Respirators can support a patient's failin...
Volles, D. F. (2011, April 11). University of Virginia Health System Adult and Geriatric Sedation/Analgesia for Diagnostic and Therapeutic Procedures. Retrieved May 12, 2011, from University of Virgina Health System: University of Virginia Health System Adult and Geriatric Sedation/Analgesia for Diagnostic and Therapeutic Procedures
...e operating table and the nurse anesthetist begins to place the monitors on them. Next, everyone in the room confirms the patient’s name and the scheduled operation. Then the nurse anesthetist puts the anesthesia in the patient’s IV. Once the patient is asleep, the CRNA manages his/her airway. To do this they place an endotracheal tube through the patient’s mouth, allowing them to breathe anesthesia gases. Now the operation can begin.
Webster CS, Merry AF, Larsson L, McGrath KA, Weller J. The frequency and nature of drug administration error during anaesthesia. Anaesth Intensive Care 2001; 29: 494-500.
Moderate sedation may also be obtained through the use of a sedative drug provided via IV. This sedation works quickly, and the dentist can change the amount of sedation provided at any time during the procedure. Some patients like knowing they don't have to worry about the sedation wearing off before they are done. For those with a strong fear of the dentist, general anesthesia or deep sedation offers the highest level of unconsciousness. Patients using these medications will be totally or almost unconscious throughout the work day.
Several skills are beneficial to the nurse and paramedic, but perhaps one of the most important skills is the ability to place an intravenous catheter into a vein. This procedure is most commonly referred to as “starting an IV”. In today’s medical community, intravenous cannulation is necessary for the administration of many antibiotics and other therapeutic drugs. Listed below are the procedures and guidelines for starting a successful IV. Following these instructions will provide a positive experience for the patient and clinician.