EMS World

JUL 2018

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 | JULY 2018 47 Taking the Pressure We know most ET tubes have an inflatable cuff to help secure placement and minimize air leak- age. The same is true for many alternative air- ways. If a cuff is present, we want to inflate it with the recommended amount of air (more on where to find that in our next article). In addition to inflating the cuf f (if present) with the amount of air detailed in the manufac- turer's instructions, another common option, especially in the hospital, is the use of cuff pres- sure manometers. Commonly used in anesthe- sia and intensive care units to monitor endotra- cheal tube pressures, these are now becoming more utilized in critical transpor t and EMS as well, and with good reason: Research shows that, as a rule, providers tend to seriously overin- flate the cuffs of endotracheal tubes. They may be even more likely to overinflate the balloons/ masks of alternative air ways to ensure a proper seal. However, published research details com- plications associated with overinflation, includ- ing the potential for damage and necrosis to surrounding air way tissues. Inflation guidelines—i.e., the amounts of air listed on the tube or package—are just guide- lines. Some patients' air ways need more, and of course some need less. The syringe size on the tube or package is a nice way to tailor what size syringe to use for inflation—i.e., don't hook a 60-mL syringe to an infant-size King air way. Interestingly, the same manometers utilized in the hospital setting for endotracheal tubes can be used for monitoring alternative air ways as well. It's the same toy, just for different tubes! In our next article we'll look at where to find information on alternative air way devices. ABOUT THE AUTHORS Scott DeBoer, RN, MSN, CPEN, CEN, CCRN, CFRN, EMT-P, is an international pediatric seminar leader and nurse consultant with more than 30 years of nursing experience. He retired from flight nursing in 2015 following more than 20 years with the University of Chicago Hospitals' UCAN flight team. He is the founder and primary seminar leader for Pedi-Ed-Trics Emergency Medical Solutions. Michael Rushing, NRP, RN, BSN, CEN, CPEN, CFRN, TCRN, CCRN-CMC, is AHA coordinator for Baptist Health Care, Pensacola, Fla., and paramedic adjunct professor at Northwest Florida State College, Niceville, Fla. Lisa DeBoer is president and cofounder of Pedi-Ed-Trics Emergency Medical Solutions. Michael Seaver, RN, BA, is a healthcare informatics consultant based in Chicago. AIRWAY For printable PDFs of these airway/color charts, see PediEd.com/airwaycharts. Handtevy System www.handtevy.com Developed by Peter Antevy, MD, & Scott DeBoer, RN, MSN, Dec. 2017 Broselow-Luten System www.ebroselow.com Developed by Robert Luten, MD, & Scott DeBoer, RN, MSN, Sept. 2017

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