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Retrograde Intubation


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Poll: retrograde intubation (27 member(s) have cast votes)

Does your service have retrograde intubation as part of its airway management protocol?

  1. Yes (5 votes [18.52%])

    Percentage of vote: 18.52%

  2. No (22 votes [81.48%])

    Percentage of vote: 81.48%

  3. What is retrograde intubation? (0 votes [0.00%])

    Percentage of vote: 0.00%

If you do NOT have retrograde intubation as part of your protocol, why not?

  1. Takes too long / too difficult (5 votes [18.52%])

    Percentage of vote: 18.52%

  2. We have too many other adjuncts to worry about adding this technique (14 votes [51.85%])

    Percentage of vote: 51.85%

  3. I don't know - I never thought about it (6 votes [22.22%])

    Percentage of vote: 22.22%

  4. What is retrograde intubation? (2 votes [7.41%])

    Percentage of vote: 7.41%

Have you ever performed a retrograde intubation in the field?

  1. Yes, and it worked great (2 votes [7.41%])

    Percentage of vote: 7.41%

  2. Tried it, but it didn't work (3 votes [11.11%])

    Percentage of vote: 11.11%

  3. I haven't personally, but I saw / heard of it being done once (10 votes [37.04%])

    Percentage of vote: 37.04%

  4. Never done it or heard of it being done in the field (12 votes [44.44%])

    Percentage of vote: 44.44%

Aside from standard ETI, what airway management techniques / devices does your program utilize?

  1. LMA (non-intubating) (12 votes [9.92%])

    Percentage of vote: 9.92%

  2. LMA (intubating) (2 votes [1.65%])

    Percentage of vote: 1.65%

  3. Combitube (8 votes [6.61%])

    Percentage of vote: 6.61%

  4. King LT (17 votes [14.05%])

    Percentage of vote: 14.05%

  5. Surgical cricothyrotomy (23 votes [19.01%])

    Percentage of vote: 19.01%

  6. Needle cricothyrotomy (14 votes [11.57%])

    Percentage of vote: 11.57%

  7. Bougie (24 votes [19.83%])

    Percentage of vote: 19.83%

  8. Retrograde intubation (5 votes [4.13%])

    Percentage of vote: 4.13%

  9. Glidescope (5 votes [4.13%])

    Percentage of vote: 4.13%

  10. Shikani / Bullard / other fiberoptic device (2 votes [1.65%])

    Percentage of vote: 1.65%

  11. Viewmax (5 votes [4.13%])

    Percentage of vote: 4.13%

  12. Other device (4 votes [3.31%])

    Percentage of vote: 3.31%

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#1 old school

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Posted 04 February 2009 - 03:50 PM

I am writing a formal case study on a retrograde intubation that was successfully performed in the field by a FP/FN crew, in a patient who had undergone numerous surgeries and was known to be a very difficult intubation.

As part of the case study, I am planning to include 1) a brief lit review 2) a description of how commonly or uncommonly this technique appears in EMS and HEMS protocols, and 3) a discussion on the perceived appropriateness of this technique for prehospital emergency airway management.

If anyone is aware of any research, protocols, or case studies on retrograde intubation, or has any experience or comments on the technique or what you perceive as its appropriateness in the prehospital arena (and why), please share your thoughts. In the "discussion" part of my writing I want to include a comprehensive presentation of arguments for and against the technique.

I am especially interested in hearing from our CRNA, ACNP, and MD participants.

I am also looking for a few folks who would be willing to review my case study prior to submission for publication. I'm hoping to be done with it in a couple of weeks.

Thanks.
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bring it in for the real thing

#2 KingAirNLA

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Posted 04 February 2009 - 05:14 PM

Could only pick one answer for the last question. We use several of the adjuncts that were listed.
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#3 old school

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Posted 04 February 2009 - 06:16 PM

Could only pick one answer for the last question. We use several of the adjuncts that were listed.



Hmm good point. I should have allowed multiple answers. I can't figure out how to change it now, though.

Could one of the moderators please change the last question to allow multiple answers to be chosen? Thanks!
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bring it in for the real thing

#4 BrianACNP

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Posted 04 February 2009 - 07:41 PM

Hmm good point. I should have allowed multiple answers. I can't figure out how to change it now, though.

Could one of the moderators please change the last question to allow multiple answers to be chosen? Thanks!



Fixed it. It works as I completed the poll.

Brian
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Brian, MSN, ACNP, CCRN

#5 Speed

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Posted 05 February 2009 - 03:45 AM

I've had to salvage a grotesquely failed surgical cric attempt at a small hospital with obviously difficult anatomy and a bubbling neck. Bagging was MINIMALLY providing positive pressure ventilation low and slow with occlusion. While "they" ventilated I slipped a wire in that was pulled out of the oropharynx on the next laryngoscopy attempt and snaked a 7.0 tube down easily and switched to that. I actually took my time and the patient was ventilated the whole time. No problem. I've used the "Seldinger Technique" innovatively like any medic does to get things into people. My company quit ordering the kits so I now keep an extra long sterile wire (thats all you need) in every uniform I wear. Just another trick in the bag I guess.
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Mike Williams CCEMT-P/FP-C

#6 Gila

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Posted 05 February 2009 - 05:02 AM

Poll completed.
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Christopher Bare
"Non fui, fui, non sum, non curo "

#7 LearRRT-CCEMTP

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Posted 06 February 2009 - 11:01 PM

Poll completed.



You may see our protocol at http://www.airbornec....com/scope.html
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David W. Garrard, BHS, RRT, RCP, CCEMTP, PNCCT
Program Director and Vice President
AAC - Air Ambulance Caribbean, Inc. D/B/A Flight 4 Life
Charlotte Amalie, St. Thomas, USVI

#8 MSDeltaFlt

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Posted 28 June 2009 - 04:42 PM

Personally, if you can't do it directly or, God forbid, even with a bougie, cut 'em. Low tech is the best tech. This is an Occam's Razor kind of thing.

My humble 0.02
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Mike Hester, RRT/NRP/FP-C
Courage is resistance to fear, mastery of fear - not absence of fear -- Mark Twain

#9 ninjamedic

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Posted 22 July 2009 - 10:33 PM

In the past we haven't done any wire guided procedures (Ground 911) although now that we are adding the Cook Melker Cric kit to our trucks we will have the equipment needed to do a retrograde unknown yet if our new medical director that is coming on board will consider adding retrogrades but it wouldn't surprise me.
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#10 BackcountryMedic

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Posted 23 July 2009 - 01:34 AM

In the past we haven't done any wire guided procedures (Ground 911) although now that we are adding the Cook Melker Cric kit to our trucks we will have the equipment needed to do a retrograde unknown yet if our new medical director that is coming on board will consider adding retrogrades but it wouldn't surprise me.


Unless it has changed the wire in the Melker isn't long enough to do a quality retrograde. It may be possible, but when I tried to practice this I could not get a hold of both ends at once and the wire threatened to disappear in the trachea. Try it yourself, but my experience is it couldn't be done well.
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"If everybody is thinking alike, then somebody isn't thinking" - Patton

#11 samflightmedic

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Posted 23 July 2009 - 06:38 PM

I've had to salvage a grotesquely failed surgical cric attempt at a small hospital with obviously difficult anatomy and a bubbling neck. Bagging was MINIMALLY providing positive pressure ventilation low and slow with occlusion. While "they" ventilated I slipped a wire in that was pulled out of the oropharynx on the next laryngoscopy attempt and snaked a 7.0 tube down easily and switched to that. I actually took my time and the patient was ventilated the whole time. No problem. I've used the "Seldinger Technique" innovatively like any medic does to get things into people. My company quit ordering the kits so I now keep an extra long sterile wire (thats all you need) in every uniform I wear. Just another trick in the bag I guess.



Mike, Where do you order your extra long sterile wires from? Thanks. Todd
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