EMS World

OCT 2015

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ALTERNATIVE AIRWAYS recommended technique. Using a flexible fiber-optic scope or optical stylet is gener- ally preferred. • With other supraglottic devices, blind intubation with or without a bougie is gener- ally not recommended. Intubation is very easy when using a flexible fiber-optic scope. One study found that with use of a scope, anesthesia trainees with minimal fiber- optic scope experience were just as suc- cessful as experienced anesthesiologists at placing ETTs through LMAs. 22 See Figure 3. Can you hook these airways up to a ventilator? • Yes! They do it all the time in ORs, and it's common for many f light and ground medical transport agencies. Can you perform diagnostic imaging (x-ray/CT/MRI) with them in place? • Extraglottic devices don't mess up imaging, and they can mean fewer delays in getting the patient to imaging areas. Can you do cricothyrotomies with alternative airways in place? • Absolutely! Hands down the prettiest crics we've ever seen were performed with alternative airways in place. The patients were alive (bonus), with reasonable sats and EtCO 2 s, just with alternative airways. Can you use alternative airways on patients with pierced tongues? • There have been no reports to the contrary. There is only one published case report of a patient with tongue jewelry who had a laryngeal mask airway placed. Anesthesia noted the jewelry was there and placed the airway with no complications. 23 Can an extraglottic airway be used when gastric decompression is needed? • If you can shove the really big tube down into their airway, putting a smaller one down a predetermined hole is beyond easy. In New Mexico EMT-Bs can place a gastric tube through an alternative airway that has a channel intended for that purpose. This is far easier than inserting a gastric tube through the nose or mouth. We are only applying suc- tion, not instilling fluids or medications. If we get it wrong, it is unlikely to result in any harm. • Even if your system does not allow gas- tric decompression, the patient can partially "self-decompress" air or liquids through the gastric access tube. • With medical director approval, we suggest "preloading" the King airway or laryngeal mask airway with the gastric tube prior to insertion. This means placing the gastric tube into the alternative airway before putting the alternative airway into the patient. It's so much easier to pass the gastric tube if it's preloaded, and you're more likely to remember to use it! We believe the chances of your patient aspirating are far less with alternative airways than with traditional bag-mask ventilation or even intubation (unless you have first-pass success). The odds are even better if you can decompress the stomach. See Figures 4, 5. 46 OCTOBER 2015 | EMSWORLD.com Figure 4: King airway with gastric tube. Ambu Figure 3: Intubation with flexible scope through alternative airway. Ambu

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