EMS World

JAN 2019

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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EMSWORLD.com | JANUARY 2019 31 everything ready so you don't have to reach for a stethoscope or a stylet. "Intubation can be like a golf swing," the 62-year-old professor adds. "Sometimes it turns out better when you slow it down a bit." Werfel encourages students to see tar- get-rich environments like ORs as good places to practice airway management that doesn't necessarily include ETI. "If you happen to get a tube, great, but you should be manipulating airways and bagging every patient you see. If it were up to me, I'd send EMT students there too," he says. Beyond Psychomotor Skills Ogilvie's diabetic male was pronounced at the ED soon after arrival. Wes thinks the patient's trachea may have been obstruct- ed. Braude wonders if the King had been inserted too far into the esophagus and needed to be pulled back a few centime- ters. We'll never know because hospitals were not yet sharing diagnoses and disposi- tions routinely with EMS. Braude highlights outcome data col- lection and analysis as key elements of improved airway management and sees EMS agencies as eventual contributors and beneficiaries of such information. Mean- while, he urges paramedics to value clinical knowledge over cool tools. "We've come a long way," he says, "but we still have to get past the point where prehospital airway management is defined by a specialized procedure or device. Inva- sive techniques in EMS rarely save lives. Instead we should focus on the basics: a knowledge of the physiology and how we can best maintain that physiology." REFERENCES 1. Steuerwald M, Braude D, Petersen T, et al. Preliminary report: Comparing aspiration rates between prehospital patients managed with extraglottic airway devices and endotracheal intubation. Air Medical Journal, 2018; 37(4): 240–3. 2. Wang H, Schmicker R, Daya M, et al. Effect of a strategy of initial laryngeal tube insertion vs endotracheal intubation on 72-hour survival in adults with out-of-hospital cardiac arrest. JAMA, 2018; 320(8): 769–78. 3. Segal N, Yanopoulos D, Mahoney B, et al. Impairment of carotid artery blood flow by supraglottic airway use in a swine model of cardiac arrest. Resuscitation, 2012; 83(8): 1,025–30. 4. Michalek P, Donaldson W, Vobrubova E, Hakl M. Complications associated with the use of supraglottic airway devices in perioperative medicine. BioMed Research International, 2015; 2015(6): 1–13. ABOUT THE AUTHOR Mike Rubin is a paramedic in Nashville and a member of EMS World's editorial advisory board. Contact him at mgr22@prodigy.net. Intubation can be like a golf swing. Sometimes it turns out better when you slow it down a bit. A simple and effective device to secure the airway ® For a Demonstration - Contact your distributor, or see www.adroitsurgical.com

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