EMS World

OCT 2015

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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Which One? Bagging does work, and intu- bation is traditionally consid- ered the preferred advanced airway management tech- n ique. But nu merou s alternatives exist. There are a variety of styles of extraglottic devices to choose from, and the devices offer a variety of helpful features, from pediatric sizes and gastric decompression to features that support the exchange of the extraglottic air- way for an ET tube. Extraglottic airways are applicable in vir- tually all circumstances and locations where airway management is needed, and their placement is generally much easier than bagging or intubation. They are also known to provide excellent patient ventilation. Efficient use of time and personnel com- bined with effective airway management sounds like a winner all around. But remem- ber, it's imperative to know the ins and outs of the alternative airways you carry. REFERENCES 1. Beauchamp G, Phrampus P, Guyette FX. Simulated rescue airway use by laypersons with scripted telephonic instruction. Resuscitation, 2009 Aug; 80(8): 925–9. 2. Bickenbach J, Schalte G, Beckers S, et al. The intuitive use of laryngeal airway tools by frst year medical students. BMC Emerg Med, 2009 Sep 22; 9: 18. 3. Wharton NM, Gibbison B, Gabbott DA, et al. I-gel insertion by novices in manikins and patients. Anaesthesia, 2008 Sep; 63(9): 991–5. 4. Hagberg C, Bogomolny Y, Gilmore C, et al. An evaluation of the insertion and function of a new supraglottic airway device, the King LT, during spontaneous ventilation. Anesth Analg, 2006 Feb; 102(2): 621–5. 5. Brimacombe JR, Berry A. The incidence of aspiration associated with the laryngeal mask airway: a meta-analysis of published literature. J Clin Anesth, 1995 Jun; 7(4): 297–305. 6. Braude D. Rapid Sequence Intubation & Rapid Sequence Airway: An Airway911 Guide, 2nd ed. Albuquerque, NM: Airway 911, 2009. 7. Genzwuerker HV, Vollmer T, Ellinger K. Fibreoptic tracheal intubation after placement of the laryngeal tube. Brit J Anesth, 2002; 89(5): 733–8. 8. de Lloyd L J, Subash F, Wilkes AR, Hodzovic I. A comparison of fbreoptic-guided tracheal intubation through the Ambu Aura-i, the intubating laryngeal mask airway and the i-gel: a manikin study. Anaesthesia, 2015 May; 70(5): 591–7. 9. Walls RM, Murphy MF. Manual of Emergency Airway Management, 4th ed. Philadelphia: Lippincott, Williams & Wilkins, 2012. 10. Denver Metro Airway Study Group. A prospective multicenter evaluation of prehospital airway management per formance in a large metropolitan region. Prehosp Emerg Care, 2009 Jul–Sep; 13(3): 304–10. 11. Thomas MJ, Benger J. Prehospital intubation in cardiac arrest: the debate continues. Resuscitation, 2011 Apr; 82(4): 367–8. 12. Hansen M, Lambert W, Guise JM, et al. Out-of-hospital pediatric airway management in the United States. Resuscitation, 2015 May; 90: 104–10. 13. Fouche PF, Simpson PM, Bendall J, et al. Airways in out-of- hospital cardiac arrest: systematic review and meta-analysis. Prehosp Emerg Care, 2014 Apr–Jun; 18(2): 244–56. 14. Wang HE, Szydlo D, Stouf fer JA, et al.; ROC investigators. Endotracheal intubation versus supraglottic airway insertion in out-of-hospital cardiac arrest. Resuscitation, 2012 Sep; 83(9): 1,061–6. 15. Gahan K, Studnek JR, Vandeventer S. King LT-D use by urban basic life support frst responders as the primary airway device for out-of-hospital cardiac arrest. Resuscitation, 2011 Dec; 82(12): 1,525–8. 16. Kurola J, Harve H, Kettunen T, et al. Airway management in cardiac arrest—comparison of the laryngeal tube, tracheal intubation and bag-valve mask ventilation in emergency medical training. Resuscitation, 2004 May; 61(2): 149–53. 17. Lossius HM, Roislien J, Lockey DJ. Patient safety in pre- hospital emergency tracheal intubation: a comprehensive meta-analysis of the intubation success rates of EMS providers. Crit Care, 2012 Feb 11; 16(1): R24. 18. Tiah L, Kajino K, Alsakaf O, et al. Does pre-hospital endotracheal intubation improve survival in adults with non- traumatic out-of-hospital cardiac arrest? A systematic review. West J Emerg Med, 2014 Nov; 15(7): 749–57. 19. Segal N, et al. Impairment of carotid artery blood fow by supraglottic airway use in a swine model of cardiac arrest. Resuscitation, 2012 Aug; 83(8): 1,025–30. 20. White JM, Braude DA, Lorenzo G, Hart BL. Radiographic evaluation of carotid artery compression in patients with extraglottic airway devices in place. Acad Emerg Med, 2015 May; 22(5): 636–8. 21. Tom McGrail, King Systems, personal conversation, May 1, 2015. 22. Hodzovic I, Janakiraman C, Sudhir G, et al. Fibreoptic intubation through the laryngeal mask airway: ef fect of operator experience. Anaesthesia, 2009 Oct; 64(10): 1,066–71. 23. Symons I. Body piercing. Anaesthesia, 2000 Mar; 55(3): 305. Thanks to the following companies for supplying photos for the article: Ambu, www.ambuusa.com Bound Tree Medical, www.boundtree.com Intersurgical, www.intersurgical.com Medtronic, www.medtronic.com Mercury Medical, www.mercurymedical. com Teleflex, www.teleflex.com EMSWORLD.com | OCTOBER 2015 47 Figure 5: Laryngeal mask with gastric tube. Ambu ABOUT THE AUTHORS Scott DeBoer, RN, MSN, CPEN, CEN, CCRN, CFRN, EMT-P, is a critical care transport nurse with MedEx in Chicago, a pediatric consultant for Ambu USA and the founder of Peds-R- Us Medical Education. Darren Braude, MD, EMT-P, is a professor of emergency medicine and anesthesiology at the University of New Mexico School of Medicine and EMS fellowship director at the University of New Mexico Health Sciences Center in Albuquerque. He is medical director for The Difficult Airway Course: EMS, from First Airway, LLC. Michael Seaver, RN, BA, is a healthcare informatics consultant based in Grayslake, IL. John Pisowicz, RN, BSN, NRP, PI, is a critical care transport nurse with Lutheran Ground in Ft. Wayne, IN, and a nurse educator at the Indiana University Health Starke Hospital in Knox, IN. He is a lieutenant in the U.S. Navy attached to 4th Medical Battalion.

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