Guest guest Posted February 10, 2001 Report Share Posted February 10, 2001 Gene,if you remember, way back in the old days(in the 80's) we used c-collars as a means to controll et tube displacement. We also used that sticky white tape around the tube and attached it to the collar. Some time in the late 80s/early 90s we began to use tube tammers and such. (note: sounds like a long time ago,don't it) DAVID WITCHER BS LP NREMTP and a bunch of other stuff _________________________________________________________________ Get your FREE download of MSN Explorer at http://explorer.msn.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2001 Report Share Posted February 11, 2001 Thing about this technique is the statement one of the doctors I have encountered made, " Now I have to clear the patients c-spine and that will delay care " . Picked up jaw, explained reason for immobilization. Was told that was " Stupid and time wasting " . I have had co-workers refuse to perform the procedure due to lack of need as the 'patient didn't fall down' when I told them to do it (that didn't last long). Then there is the patient that no darn c-collar on my unit will fit..but lets not go there. Needless to say, I feel that this is a procedure that should become a standard of care. Why? Because without the airway, we shouldn't bother doing anything else. So why not waste that extra two minutes to make sure the airway is protected? I have also found that having the patient on a LSB (long spine board) is perhaps one of the most effective methods of moving the patient about, especially on stairs (those cots are HEAVY). Just my two cents, Webb, LP FLW EMS, MO _________________________________________________________________ Get your FREE download of MSN Explorer at http://explorer.msn.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2001 Report Share Posted February 11, 2001 I sometimes think that we get caught up in the safe guards, gijets, trinkets, gajets and so forth. I am talking about the cervical stabilizations and buretrols. Should we not just use common sense and assess, assess, assess and reassess our patients. For god sakes, just monitor your patients closely and correct problems as they occur. I have intubated many patients and (knock on wood) have never misplaced nor had one come dislodged and I have not routinely provided cervical stabilization on my intubated patients. Now for buretrols, unless a patient is less than 10kg (approx. 1 Y/O), I do not think that they are a must, however I would hang my fluid on a 60 gtt set for a little safety. If you have started fluids and have noticed that 200cc's of fluids have gone in inadvertently (it will take a little while for that amount of fluid to go in, even using a 22 ga angio), then you still are within the normal bolus level for the child. Fluid overload should not be a problem unless there are other issues. This is true for any age patient. To me it seems that it all boils down to assessment and reassessment of the patient and the interventions being used. Just my thoughts Verne Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2001 Report Share Posted February 11, 2001 Anecdotally I have seen secured ET tubes literally coughed out of the trachea by patients (twice in 30 years). I have also seen; more times then I care to remember; instances where members of the EMS crew or hospital team get in a hurry and move the patient before telling the person bagging the patient that they are moving. This tends to yield a person standing alone holding a BMV attached to an ET Tube ventilating the room with oxygen while the patient is about 10 feet away and turning a lovely shade of blue. Also bear in mind that 10 cc in an ET Cuff may not actually provide an effective seal in some patients (the bull-necked individual). Localized swelling caused by a less then optimal tube placement maneuvers may resolve quickly and the properly inflated ET Cuff may now be of inadequate volume. Regarding neck movement, remember, while the tube is relatively immobile, the soft tissue structures of the throat and larynx are pliable and flexible. Constant movement will move the ET tube about. Hence each intubated patient in an ICU setting gets a chest x-ray each day to (among other things) visually document the tip of the ET tube and it's position. Occasionally the tube slips and moves into the right mainstem bronchus or rides up higher in the trachea and has to be withdrawn and repositioned. I am a very strong proponent of buretrols and small volume (no more then 500cc) IV bags used in conjunction with IV pumps (belt, suspenders, and anything else I can utilize type of protocol) for kids. Sure the buretrols can be a pain to initially prime and get started, but without them it is very easy to overload a kid. It also makes med delivery (primarily antibiotics) much easier to give without overloading the kid as well. Just add the ordered amount of antibiotics to the hour's fluid in the buretrol and the kid receives the dose over an hour (in theory) without additional significant added fluid volume. The same goes for fluid resuscitation. If the kid weighs 3.5 kg and the protocol requires a fluid bolus of 5cc/kg,(yes I am aware that the standard bolus is a MAX of 20cc/kg-it is easier to give more fluid then to hook the kid's IV up to suction and attempt to retrieve an overzealous fluid bolus(just kidding folks)) simply put 17-18 cc in the buretrol and open it w/o and watch it flow in. A bit difficult to do with the standard IV bag and much less hassle of drawing up the 17-18 cc in a 20 cc syringe and hand pushing it in. Manual pushing of meds and fluid volume is more traumatic to the vein and increases the risk of infiltration. If the kid needs an additional fluid bolus, repeat the fluid in the buretrol's chamber and away it goes; no fuss; no muss. Stay safe Easley Re: [texasems-L] Re: Immobilization of intubated patients I have a question about this. We routinely inflate the bulb at the end of the ET tube to prevent aspiration of stomach contents and to stabilize the tube in the trachea. If the tube is inflated to proper pressure and no stomach contents can get past the bulb, how can it move? If it can move, can it not also allow stomach contents to seep past the bulb? Is the source of the movement the fact that we are anchoring the tube at the mouth across a potentially moveable joint, the neck? If we did not anchor the tube, would not the neck flex along the tube portion and the bulb portion remain immobile? Maybe I have not yet had enough coffee this morning, but these questions popped into my mind. I think all the research that has been done has been with the tube anchored at the mouth. Maybe we should rethink this. I would be interested in hearing what the group has to say about this. As far as fluid administration to pediatrics, we do not use Buretrols(more a cost issue than anything else). We use the multidrop set and set it at 60gtts. We also use 500cc bags rather than the 1000cc as we found that it cost us less. The large majority of our patients are medical and do not require large volumes of fluid and we were wasting a lot of money with the large bags hung TKO. With frequent reassessment, we have never had a problem with fluid overload even on a critical patient. Jeanne E. Amis, RN, LP Education Director Marfa City/County EMS Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2001 Report Share Posted February 11, 2001 I have a question about this. We routinely inflate the bulb at the end of the ET tube to prevent aspiration of stomach contents and to stabilize the tube in the trachea. If the tube is inflated to proper pressure and no stomach contents can get past the bulb, how can it move? If it can move, can it not also allow stomach contents to seep past the bulb? Is the source of the movement the fact that we are anchoring the tube at the mouth across a potentially moveable joint, the neck? If we did not anchor the tube, would not the neck flex along the tube portion and the bulb portion remain immobile? Maybe I have not yet had enough coffee this morning, but these questions popped into my mind. I think all the research that has been done has been with the tube anchored at the mouth. Maybe we should rethink this. I would be interested in hearing what the group has to say about this. As far as fluid administration to pediatrics, we do not use Buretrols(more a cost issue than anything else). We use the multidrop set and set it at 60gtts. We also use 500cc bags rather than the 1000cc as we found that it cost us less. The large majority of our patients are medical and do not require large volumes of fluid and we were wasting a lot of money with the large bags hung TKO. With frequent reassessment, we have never had a problem with fluid overload even on a critical patient. Jeanne E. Amis, RN, LP Education Director Marfa City/County EMS Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2001 Report Share Posted February 11, 2001 Thanks, Marc, I have been known to Xerox articles and hand them to doctors and others who questioned techniques such as this. We must continually battle the forces of the uninformed. Gene Gandy In a message dated 2/11/2001 1:06:11 Central Standard Time, MMMeyer1@... writes: > Subj: [texasems-L] Re: Immobilization of intubated patients > > > Gene, > > I don't remember when this was published in JEMS (probably 2-3 years > ago), and it was a 'research' article, not one of the tricks of the > trade pieces. I do try to immobilize the neck when I remember to do > it, but I routinely get a look of utter and profound disbelief when I > roll into the ED with a patient immobilized as such. I was routinely > asked by EM physicians in some of Houston's biggest hospitals; " Why > do you have that on? Did the patient fall? " Needless to say, many of > my coworkers have not even heard of this technique. So much for > thinking outside the box. > > Marc Meyer, RN, LP > Engineer-Operator/Paramedic, Houston Fire Department > Staff Nurse, St. Luke's Episcopal Hospital > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2001 Report Share Posted February 11, 2001 , I find your comment that you have protocols that require a 5 per kg bolus interesting. I am not disputing you or your protocols, I just wonder if the protocols you use are in line with the local pediatric facilities views. I have worked at a pedi ER for the last 18 months and have never seen less than a 20 per kg bolus given. You are correct in saying that 20 per kg is the max single bolus. We simply give that and reassess. I have seen as much as 60 per kg given in 3 back to back boluses. I have seen an inadvertent bolus of 40 per kg given (because a pump was set wrong) and I have not seen any child fluid overloaded to the point that required any intervention. I also agree that you should have extra safeguards for kids less 10kg. Also let me say that we do on every child hang a buretrol then simply let the chamber fill to the top and place it on a pump. If the child is admitted to the hospital, then the chamber is used correctly because the fluids are not as closely monitored. Just remember that I am not arguing with you, I am very well aware that for every group of physicians that there is a different way of handling any given situation. This flows down hill because we see them as all knowing (sort of) and this is where we gain our expertise and standard/protocol. I would never condemn anyone following the standard/protocol in your area. Have a good week Verne The same goes for fluid resuscitation. If the kid weighs 3.5 kg and the protocol requires a fluid bolus of 5cc/kg,(yes I am aware that the standard bolus is a MAX of 20cc/kg-it is easier to give more fluid then to hook the kid's IV up to suction and attempt to retrieve an overzealous fluid bolus(just kidding folks)) simply put 17-18 cc in the buretrol and open it w/o and watch it flow in. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2001 Report Share Posted February 11, 2001 The 5cc/kg bolus used as an example protocol bolus was meant as a demonstration of the difficulty in giving small amounts of fluid accurately, not indicating an actual protocol in use. Stay safe Easley Re: [texasems-L] Re: Immobilization of intubated patients , I find your comment that you have protocols that require a 5 per kg bolus interesting. I am not disputing you or your protocols, I just wonder if the protocols you use are in line with the local pediatric facilities views. I have worked at a pedi ER for the last 18 months and have never seen less than a 20 per kg bolus given. You are correct in saying that 20 per kg is the max single bolus. We simply give that and reassess. I have seen as much as 60 per kg given in 3 back to back boluses. I have seen an inadvertent bolus of 40 per kg given (because a pump was set wrong) and I have not seen any child fluid overloaded to the point that required any intervention. I also agree that you should have extra safeguards for kids less 10kg. Also let me say that we do on every child hang a buretrol then simply let the chamber fill to the top and place it on a pump. If the child is admitted to the hospital, then the chamber is used correctly because the fluids are not as closely monitored. Just remember that I am not arguing with you, I am very well aware that for every group of physicians that there is a different way of handling any given situation. This flows down hill because we see them as all knowing (sort of) and this is where we gain our expertise and standard/protocol. I would never condemn anyone following the standard/protocol in your area. Have a good week Verne The same goes for fluid resuscitation. If the kid weighs 3.5 kg and the protocol requires a fluid bolus of 5cc/kg,(yes I am aware that the standard bolus is a MAX of 20cc/kg-it is easier to give more fluid then to hook the kid's IV up to suction and attempt to retrieve an overzealous fluid bolus(just kidding folks)) simply put 17-18 cc in the buretrol and open it w/o and watch it flow in. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2001 Report Share Posted February 12, 2001 To Gene and Mark, I have the original articles from JEMS publications given to my by the editor A.J. Heightman. If you would like, I will be glad to fax/mail them to either one of you. They are not available on the JEMS web site any longer. They are titled: The Truth About ET Tube Movement, Written by Matera, MD, EMT-P. June/1998. Anchor The Airway, Written and Researched by M. Peinol, MD, Randy E. Price EMT-P and Gaston County EMS (N.C.) June/1998 Craig Gray cgray@... MMMeyer1@... wrote: > Gene, > > I don't remember when this was published in JEMS (probably 2-3 years > ago), and it was a 'research' article, not one of the tricks of the > trade pieces. I do try to immobilize the neck when I remember to do > it, but I routinely get a look of utter and profound disbelief when I > roll into the ED with a patient immobilized as such. I was routinely > asked by EM physicians in some of Houston's biggest hospitals; " Why > do you have that on? Did the patient fall? " Needless to say, many of > my coworkers have not even heard of this technique. So much for > thinking outside the box. > > Marc Meyer, RN, LP > Engineer-Operator/Paramedic, Houston Fire Department > Staff Nurse, St. Luke's Episcopal Hospital > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2001 Report Share Posted February 12, 2001 I would appreciate it very much if you could fax to me at , attn: Gene Gandy. Thanks E. Gandy, JD, LP EMS Professions Program Tyler Junior College Tyler, TX Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2001 Report Share Posted February 12, 2001 I'm getting the articles faxed and will have more to say. Gene E. Gandy, JD, LP EMS Professions Program Tyler Junior College Tyler, TX Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2001 Report Share Posted February 12, 2001 Gene: I'm not at all sure this procedure could be said to have originated from empirical observation. As I recall from the JEMS articles, this WAS dreamed up as the result of two separate formal clinical research projects. Each started with the hypothesis that subtle flexion/extension movements, caused by the motion of the cot while rolling or secured in the patient compartment, caused a " walking " motion of the ET tube that made it possible for it to displace. This was even if the tube was " properly " secured. I believe they first got onto this idea by using intubated cadavers which they manipulated in various ways to see if there was some explanation for spontaneous extubations. That established the hypothesis. I'll have to hunt up the issue that had the reports to refresh my memory on exactly how they then gathered data to test the hypothesis, but I remember that it was done in a perfectly defendable, scientific manner. I was very impressed because one of the providers that did this was a fire-based EMS service and I hadn't previously associated this type of provider with any interest in pushing back the grey areas of our practice. The point I'm trying to make, Gene, is that this idea came from the type of scientific investigation and research we all keep saying we should be doing more of, not from a few guys on the truck who just came up with the idea and began using it. Also, just in case anyone thought I was wagging a finger of criticism at EMS services that don't use cervical immobilization as part of the intubation procedure, I wasn't. I genuinely was curious about why services aren't using this. Have they never heard of the research? Did they look at it and decide it wasn't valid? Does their medical director object? Did Asklepios descend from Olympus and personally tell them not to? There a numerous legitimate reasons ( and more than a couple of illegitimate ones) why EMS services might not be doing this and I was just wondering what those reasons are. Dave [texasems-L] Re: Immobilization of intubated patients > Dave J. recommends that some type of head and neck immobilization be employed > in patients who are ET Intubated to restrict flexure/extension of the neck > which might displace the tube. He asks the question: If you're not doing > this, why not? > > Good question. Once again I find that this is not being taught universally > in initial courses nor in CE, probably for the simple reason that it doesn't > appear in the TDH checkoff sequence as a necessary step and is probably an > empirically accepted method rather than a research/textbook driven practice. > > It also requires a little extra work and time to apply a CID to the patient. > Perhaps it's one of those " Tricks of the Trade " (remember the column in JEMS > originated by that great mossback Dick Thom?) that some are afraid to teach > because it's not " officially " recognized. > > Any comments? > > Gene > > E. Gandy, JD, LP > EMS Professions Program > Tyler Junior College > Tyler, TX > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2001 Report Share Posted February 12, 2001 Verne: What you are saying, I believe, is that no device is a substitute for common sense and careful observation of a patient. I agree 100%. That said, however, remember that reassessing the patient can only help us spot a displaced tube before it causes the patient harm. It can't keep the tube from becoming dislodged in the first place. The research shows that the typical methods used to secure the tube, home-grown and commercial, aren't full protection either because they don't deal with the cause of those displacements. Cervical immobilization does. Most intubated patients require enough of our concentration because of their overall patient care need that having to stop and reintubate is a major problem best avoided. It seems to me that taking a simple step that costs only a few seconds of extra time right at the beginning, but that reduces the liklihood that the tube is going to move, is good extra insurance that you won't have to drop everything and reintubate. It's no substitute for vigilance, but it isn't intended to be. The same thing is true with buretrols. We don't HAVE to use them. We can get along without them. However, they make certain medication administrations in the field easier if they are available and, when used on pedis, they minimize the chance of overhydrating a child. All these things are just tools. If you are not a good craftsman, you can have every fancy gimmick in the book and the result will be medicocre. If you are good, you can work wonders with basic tools only. Nevertheless, the best craftsmen invest in the best tools for each job and they master their use. The result is even better when you have the best tools and know how to use them. Why should good paramedics do without the more effective tools to do their jobs if they can afford them and are willing to master them? Its better for their patients and its better for them. The only things the gadgets and such you are talking about are no good for is making poor paramedics more competent. Dave Re: [texasems-L] Re: Immobilization of intubated patients > I sometimes think that we get caught up in the safe guards, gijets, > trinkets, gajets and so forth. I am talking about the cervical > stabilizations and buretrols. Should we not just use common sense and > assess, assess, assess and reassess our patients. For god sakes, just > monitor your patients closely and correct problems as they occur. I have > intubated many patients and (knock on wood) have never misplaced nor had one > come dislodged and I have not routinely provided cervical stabilization on > my intubated patients. Now for buretrols, unless a patient is less than > 10kg (approx. 1 Y/O), I do not think that they are a must, however I would > hang my fluid on a 60 gtt set for a little safety. If you have started > fluids and have noticed that 200cc's of fluids have gone in inadvertently > (it will take a little while for that amount of fluid to go in, even using a > 22 ga angio), then you still are within the normal bolus level for the > child. Fluid overload should not be a problem unless there are other > issues. This is true for any age patient. To me it seems that it all boils > down to assessment and reassessment of the patient and the interventions > being used. > > Just my thoughts > > Verne > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2001 Report Share Posted February 12, 2001 Jeanne: I think the reasoning you have provided is exactly why there has been insistence for decades that tubes didn't dislodge spontaneously and that poor paramedic intubation skills were the cause. We all knew better, but we couldn't explain it any other way ourselves. However, the research I cited showed that that reasoning, common sense though it is (and it happened to be my view, too, until I saw the research papers), was wrong. Actually, when you think about it, the same property of a properly-inflated ET cuff that holds it tight against the tracheal tissues, is probably the same property that contributes to the ability of small muscle movements to slowly walk the tube, inflated cuff and all, upwards to the point where it can actually pass back out of the glottis. We're not talking about a great distance. The passage of fluids past the interfact of the cuff and the tracheal mucosa would be a passive thing and there isn't enough fluid pressure to allow it. On the other hand, the cervical flexion/extension movements that cause tube migration produced a dynamic action on the tube, kind of like peristalsis, that gradually moved the tube. If I can find the durned articles about this and get JEMS permission, maybe we can post the text to the list. Its been too long since I read the thing originally for me to be sure I'm stating it right. Dave Re: [texasems-L] Re: Immobilization of intubated patients > I have a question about this. We routinely inflate the bulb at the end of the > ET tube to prevent aspiration of stomach contents and to stabilize the tube in > the trachea. If the tube is inflated to proper pressure and no stomach contents > can get past the bulb, how can it move? If it can move, can it not also allow > stomach contents to seep past the bulb? Is the source of the movement the fact > that we are anchoring the tube at the mouth across a potentially moveable joint, > the neck? If we did not anchor the tube, would not the neck flex along the tube > portion and the bulb portion remain immobile? Maybe I have not yet had enough > coffee this morning, but these questions popped into my mind. I think all the > research that has been done has been with the tube anchored at the mouth. Maybe > we should rethink this. I would be interested in hearing what the group has to > say about this. > As far as fluid administration to pediatrics, we do not use Buretrols(more a > cost issue than anything else). We use the multidrop set and set it at 60gtts. > We also use 500cc bags rather than the 1000cc as we found that it cost us less. > The large majority of our patients are medical and do not require large volumes > of fluid and we were wasting a lot of money with the large bags hung TKO. With > frequent reassessment, we have never had a problem with fluid overload even on a > critical patient. > Jeanne E. Amis, RN, LP > Education Director > Marfa City/County EMS > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2001 Report Share Posted February 12, 2001 Craig: If I can't find my copy of the issue where those articles were published, could you send it to me also? Dave Re: [texasems-L] Re: Immobilization of intubated patients > To Gene and Mark, > I have the original articles from JEMS publications given to my by the > editor A.J. Heightman. If you would like, I will be glad to fax/mail > them to either one of you. They are not available on the JEMS web site > any longer. They are titled: > The Truth About ET Tube Movement, Written by Matera, MD, EMT-P. > June/1998. > Anchor The Airway, Written and Researched by M. Peinol, MD, Randy > E. Price EMT-P and Gaston County EMS (N.C.) June/1998 > Craig Gray > cgray@... > > > > MMMeyer1@... wrote: > > > Gene, > > > > I don't remember when this was published in JEMS (probably 2-3 years > > ago), and it was a 'research' article, not one of the tricks of the > > trade pieces. I do try to immobilize the neck when I remember to do > > it, but I routinely get a look of utter and profound disbelief when I > > roll into the ED with a patient immobilized as such. I was routinely > > asked by EM physicians in some of Houston's biggest hospitals; " Why > > do you have that on? Did the patient fall? " Needless to say, many of > > my coworkers have not even heard of this technique. So much for > > thinking outside the box. > > > > Marc Meyer, RN, LP > > Engineer-Operator/Paramedic, Houston Fire Department > > Staff Nurse, St. Luke's Episcopal Hospital > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2001 Report Share Posted February 12, 2001 <P> Marc,</P> <P>I thought you knew better than to try to think outside the box down there?</P> <P> & nbsp;</P> <P><BR></P> <P> & nbsp; <B><I>MMMeyer1@...</I></B> wrote: <BR> <BLOCKQUOTE style= " BORDER-LEFT: #1010ff 2px solid; MARGIN-LEFT: 5px; PADDING-LEFT: 5px " ><TT>Gene,<BR><BR>I don't remember when this was published in JEMS (probably 2-3 years <BR>ago), and it was a 'research' article, not one of the tricks of the <BR>trade pieces. & nbsp; I do try to immobilize the neck when I remember to do <BR>it, but I routinely get a look of utter and profound disbelief when I <BR>roll into the ED with a patient immobilized as such. & nbsp; I was routinely <BR>asked by EM physicians in some of Houston's biggest hospitals; " Why <BR>do you have that on? Did the patient fall? " & nbsp; Needless to say, many of <BR>my coworkers have not even heard of this technique. & nbsp; So much for <BR>thinking outside the box.<BR><BR>Marc Meyer, RN, LP<BR>Engineer-Operator/Paramedic, Houston Fire Department<BR>Staff Nurse, St. Luke's Episcopal Hospital<BR><BR><BR><BR></TT><BR><!-- |**|begin egp html banner|**| --><BR> <TABLE border=0 cellPadding=2 cellSpacing=0><BR> <TBODY><BR> <TR bgColor=#ffffcc><BR> <TD align=middle><FONT color=#003399 size=-1><B>Yahoo! Groups Sponsor</B></FONT></TD></TR><BR> <TR bgColor=#ffffff><BR> <TD width=470> <FORM action=http://rd.yahoo.com/M=176325.1307935.2900315.1248727/D=egroupmail/S=17000\ 61161:N/A=572118/R=0/*http://whois.domains.yahoo.com/domains_wresults.html method=get><INPUT name=action type=hidden value=1><INPUT name=property type=hidden value=domains> <BR> <TABLE bgColor=#ffff99 border=0 cellPadding=0 cellSpacing=0 width=468><BR> <TBODY><BR> <TR><BR> <TD rowSpan=2><A href= " http://rd.yahoo.com/M=176325.1307935.2900315.1248727/D=egroupmail/S=170006\ 1161:N/A=572118/R=1/*http://domains.yahoo.com " ><IMG alt= " " border=0 height=60 src= " http://us.a1.yimg.com/us.yimg.com/a/ya/yahoo_domain/happy2.gif " width=145></A></TD><BR> <TD vAlign=top><A href= " http://rd.yahoo.com/M=176325.1307935.2900315.1248727/D=egroupmail/S=170006\ 1161:N/A=572118/R=2/*http://domains.yahoo.com " ><IMG alt= " " border=0 height=30 src= " http://us.a1.yimg.com/us.yimg.com/a/ya/yahoo_domain/happytext2.gif " width=323></A></TD></TR><BR> <TR><BR> <TD align=middle><BR> <TABLE border=0 cellPadding=0 cellSpacing=0 width=242><BR> <TBODY><BR> <TR vAlign=top><BR> <TD align=middle noWrap vAlign=center><FONT color=#000000 face= " verdana, arial " size=2>www.<INPUT name=name size=22> & nbsp;.com</FONT> & nbsp;<INPUT name=Submit type=submit value=Go!></TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE></FORM></TD></TR><\ BR> <TR><BR> <TD><IMG alt= " " height=1 src= " http://us.adserver.yahoo.com/l?M=176325.1307935.2900315.1248727/D=egroupmai\ l/S=1700061161:N/A=572118/rand=879939663 " width=1></TD></TR></TBODY></TABLE><!-- |**|end egp html banner|**| --></BLOCKQUOTE> __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2001 Report Share Posted February 12, 2001 Dave, not a problem, need your number. Craig Dave wrote: > Craig: > > If I can't find my copy of the issue where those articles were > published, > could you send it to me also? > > Dave > Re: [texasems-L] Re: Immobilization of intubated patients > > > > To Gene and Mark, > > I have the original articles from JEMS publications given to my by > the > > editor A.J. Heightman. If you would like, I will be glad to fax/mail > > > them to either one of you. They are not available on the JEMS web > site > > any longer. They are titled: > > The Truth About ET Tube Movement, Written by Matera, MD, EMT-P. > > > June/1998. > > Anchor The Airway, Written and Researched by M. Peinol, MD, > Randy > > E. Price EMT-P and Gaston County EMS (N.C.) June/1998 > > Craig Gray > > cgray@... > > > > > > > > MMMeyer1@... wrote: > > > > > Gene, > > > > > > I don't remember when this was published in JEMS (probably 2-3 > years > > > ago), and it was a 'research' article, not one of the tricks of > the > > > trade pieces. I do try to immobilize the neck when I remember to > do > > > it, but I routinely get a look of utter and profound disbelief > when I > > > roll into the ED with a patient immobilized as such. I was > routinely > > > asked by EM physicians in some of Houston's biggest hospitals; > " Why > > > do you have that on? Did the patient fall? " Needless to say, many > of > > > my coworkers have not even heard of this technique. So much for > > > thinking outside the box. > > > > > > Marc Meyer, RN, LP > > > Engineer-Operator/Paramedic, Houston Fire Department > > > Staff Nurse, St. Luke's Episcopal Hospital > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 19, 2001 Report Share Posted February 19, 2001 Craig: Thanks, guy. The fax number is Dave Re: [texasems-L] Re: Immobilization of intubated patients > > > > > > > To Gene and Mark, > > > I have the original articles from JEMS publications given to my by > > the > > > editor A.J. Heightman. If you would like, I will be glad to fax/mail > > > > > them to either one of you. They are not available on the JEMS web > > site > > > any longer. They are titled: > > > The Truth About ET Tube Movement, Written by Matera, MD, EMT-P. > > > > > June/1998. > > > Anchor The Airway, Written and Researched by M. Peinol, MD, > > Randy > > > E. Price EMT-P and Gaston County EMS (N.C.) June/1998 > > > Craig Gray > > > cgray@... > > > > > > > > > > > > MMMeyer1@... wrote: > > > > > > > Gene, > > > > > > > > I don't remember when this was published in JEMS (probably 2-3 > > years > > > > ago), and it was a 'research' article, not one of the tricks of > > the > > > > trade pieces. I do try to immobilize the neck when I remember to > > do > > > > it, but I routinely get a look of utter and profound disbelief > > when I > > > > roll into the ED with a patient immobilized as such. I was > > routinely > > > > asked by EM physicians in some of Houston's biggest hospitals; > > " Why > > > > do you have that on? Did the patient fall? " Needless to say, many > > of > > > > my coworkers have not even heard of this technique. So much for > > > > thinking outside the box. > > > > > > > > Marc Meyer, RN, LP > > > > Engineer-Operator/Paramedic, Houston Fire Department > > > > Staff Nurse, St. Luke's Episcopal Hospital > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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