Blind Insertion or Blindly Inserted: Advanced Airways Revisited

Blind insertion or blindly inserted? One thing we do in EMS that many of us most pride ourselves on is advanced airway management—though gaining that pride may have required a few moments of pants-wetting terror along the way. For patients in respiratory failure rapidly progressing to respiratory or cardiac arrest, there are few scenarios that run us right up against the front lines of life and death, and with so much potential to affect the outcome. These cases bring into focus the cognitive (knowledge), psychomotor (manual), and affective (emotional/psychological) elements of our job like nothing else we do. Yet evidence keeps piling up about how much of a mess we often find ourselves in while managing them. Skill Burn-In & Maintenance Initial skill "burn-in," for one, is inadequate. Only five live intubations are required for national certification. For perspective, emergency medicine residents and nurse anesthetists need at least 35 and 200 tubes, respectively, for certification and, in both cases, these are placed in the controlled and supervised environment of an ED or operating room.1 A 1998 study demonstrated that anesthesiology residents must place more than 50 tubes under direct supervision before they can achieve a success rate of 90%.2 Somehow, though, after those first five tubes and several years' fewer training, paramedics are miraculously supposed to hit the mark on their knees, in dark rooms, intubating morbidly obese patients with full stomac...
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Patient Care Columns Source Type: news