RE: retrograde ETT

["bryan hess" <hosshess@adelphia.net>]

I have had the past pleasure of having a Physician Advisor who did
research on the practice and promoted the use of retrograde intubations.
The service I worked for at the time was comprised of 40 people 50%
medics of varying levels of experience myself at the BSN (brand spankin'
new) stage. With his guidance we all practiced the skill on several
cadavers and on patients who were pronounced by their family physicians
in the ED (this was twelve years ago and I believe the laws governing
this type of training have been severely tightened) But with practice we
were able to complete the skill in less time, including setup and pt
prep, than a visual ETT placement. I feel very strongly that the extra
"tool in the kit" is warranted. Like any of our skills there must be
practice and competency (I know we hate that word) testing for
proficiency. As to the folks who have seen it go wrong because of
equipment or other issues, we found that having a small kit placed in a
"Vis-u-all" package (the type that is used to sterilize small
instruments) we had all the pieces and parts in one spot. This allowed
you to grab your ETT of choice and the small 3 piece kit and get the
airway secured. As far as protocol is concerned we used it as a
intermediate step to the cric. Anytime the airway was occluded to point
of needing to cut we used the retrograde method and found it to work
very well my personal favorite place to utilize it was on the severely
anterior placed trachea. The main trick is to secure a long enough
J-wire so it can protrude far enough from either the nare or the
oropharynx to allow the total length of the ETT to be placed over the
J-wire prior to insertion into either those two regions. In closing we
would all love to have the bronchoscopes and fiber optic methods at our
disposal but the fact remains that retrograde is a sound choice, it is
financially smart, has very small space and weight concerns as well as
ease of use. 

Bryan Hess, NREMT-P
Flight Medic
St. Mary's CareFlight
Grand Junction, CO
hosshess@adelphia.net



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