Guest guest Posted May 6, 2010 Report Share Posted May 6, 2010 Ok group, I normally do more reading than talking on here, but I have a question that is killing my brain, LoL. I'm studying for my NREMTP using the " Caroline's Emergency Care in the Streets 6th Edition " student workbook. Under the " Airway Management & Ventilation " chapter the question states, You have a 42 y/o female extricated from a wrecked vehicle; she is unconscious and has a depressed skull fracture at the back of her head. To secure an airway would you choose, A. Blind nasotracheal intubation as the preferred technique. B. Tracheal intubation as the preferred technique. C. Cricothyrotomy as the preferred technique. I chose " B' as my answer, and was told (by the answers in the back of the book) that the correct answer was " A " . Please correct me if I'm wrong as I am still learning, but have we not always been taught NOT to use nasotracheal intubation if the pt has a skull fracture of any kind? Everyones input will be greatly appreciated, because I really need to pass my test. Thanks, R. Democracy will cease to exist when you take away from those who are willing to work and give to those who are not. Jefferson Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2010 Report Share Posted May 6, 2010 Part of the issue here is the 6th edition is a full 4 editions ago. Granted even me a Basic knew that nasal intubation was a NO NO in the case of a skull fracture. Oh my EMT-A course in 1981 was with the brand new AAOS 2nd Ed. Louis N. Molino, Sr., CET FF/NREMT-B/FSI/EMSI Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant LNMolino@... (Cell Phone) " A Texan with a Jersey Attitude " " Great minds discuss ideas; Average minds discuss events; Small minds discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) In a message dated 5/6/2010 3:28:09 P.M. Central Daylight Time, medic0946@... writes: Rick, you were correct. Nasal intubation should be avoided in the possibility of basal skull fx. > > Ok group, > I normally do more reading than talking on here, but I have a question that is killing my brain, LoL. I'm studying for my NREMTP using the " Caroline's Emergency Care in the Streets 6th Edition " student workbook. > > Under the " Airway Management & Ventilation " chapter the question states, > > You have a 42 y/o female extricated from a wrecked vehicle; she is unconscious and has a depressed skull fracture at the back of her head. To secure an airway would you choose, > > A. Blind nasotracheal intubation as the preferred technique. > B. Tracheal intubation as the preferred technique. > C. Cricothyrotomy as the preferred technique. > > I chose " B' as my answer, and was told (by the answers in the back of the book) that the correct answer was " A " . Please correct me if I'm wrong as I am still learning, but have we not always been taught NOT to use nasotracheal intubation if the pt has a skull fracture of any kind? > > Everyones input will be greatly appreciated, because I really need to pass my test. > > Thanks, > R. > > Democracy will cease to exist when you take away from those who are willing to work and give to those who are not. > Jefferson > > > > > > [Non-text portions of this message have been removed] > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2010 Report Share Posted May 6, 2010 Part of the issue here is the 6th edition is a full 4 editions ago. Granted even me a Basic knew that nasal intubation was a NO NO in the case of a skull fracture. Oh my EMT-A course in 1981 was with the brand new AAOS 2nd Ed. Louis N. Molino, Sr., CET FF/NREMT-B/FSI/EMSI Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant LNMolino@... (Cell Phone) " A Texan with a Jersey Attitude " " Great minds discuss ideas; Average minds discuss events; Small minds discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) In a message dated 5/6/2010 3:28:09 P.M. Central Daylight Time, medic0946@... writes: Rick, you were correct. Nasal intubation should be avoided in the possibility of basal skull fx. > > Ok group, > I normally do more reading than talking on here, but I have a question that is killing my brain, LoL. I'm studying for my NREMTP using the " Caroline's Emergency Care in the Streets 6th Edition " student workbook. > > Under the " Airway Management & Ventilation " chapter the question states, > > You have a 42 y/o female extricated from a wrecked vehicle; she is unconscious and has a depressed skull fracture at the back of her head. To secure an airway would you choose, > > A. Blind nasotracheal intubation as the preferred technique. > B. Tracheal intubation as the preferred technique. > C. Cricothyrotomy as the preferred technique. > > I chose " B' as my answer, and was told (by the answers in the back of the book) that the correct answer was " A " . Please correct me if I'm wrong as I am still learning, but have we not always been taught NOT to use nasotracheal intubation if the pt has a skull fracture of any kind? > > Everyones input will be greatly appreciated, because I really need to pass my test. > > Thanks, > R. > > Democracy will cease to exist when you take away from those who are willing to work and give to those who are not. > Jefferson > > > > > > [Non-text portions of this message have been removed] > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2010 Report Share Posted May 6, 2010 Part of the issue here is the 6th edition is a full 4 editions ago. Granted even me a Basic knew that nasal intubation was a NO NO in the case of a skull fracture. Oh my EMT-A course in 1981 was with the brand new AAOS 2nd Ed. Louis N. Molino, Sr., CET FF/NREMT-B/FSI/EMSI Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant LNMolino@... (Cell Phone) " A Texan with a Jersey Attitude " " Great minds discuss ideas; Average minds discuss events; Small minds discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) In a message dated 5/6/2010 3:28:09 P.M. Central Daylight Time, medic0946@... writes: Rick, you were correct. Nasal intubation should be avoided in the possibility of basal skull fx. > > Ok group, > I normally do more reading than talking on here, but I have a question that is killing my brain, LoL. I'm studying for my NREMTP using the " Caroline's Emergency Care in the Streets 6th Edition " student workbook. > > Under the " Airway Management & Ventilation " chapter the question states, > > You have a 42 y/o female extricated from a wrecked vehicle; she is unconscious and has a depressed skull fracture at the back of her head. To secure an airway would you choose, > > A. Blind nasotracheal intubation as the preferred technique. > B. Tracheal intubation as the preferred technique. > C. Cricothyrotomy as the preferred technique. > > I chose " B' as my answer, and was told (by the answers in the back of the book) that the correct answer was " A " . Please correct me if I'm wrong as I am still learning, but have we not always been taught NOT to use nasotracheal intubation if the pt has a skull fracture of any kind? > > Everyones input will be greatly appreciated, because I really need to pass my test. > > Thanks, > R. > > Democracy will cease to exist when you take away from those who are willing to work and give to those who are not. > Jefferson > > > > > > [Non-text portions of this message have been removed] > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2010 Report Share Posted May 6, 2010 I do not recall any ET tubes through the base of the skull, but I do recall a couple of NGs that showed up as coiled in the cranium when I was in medical school years ago. ck In a message dated 5/6/2010 17:06:34 Central Daylight Time, texas.paramedic@... writes: My understanding is that nasal intubation in head injuries has become a general consensus " moot point " as there have been no documented cases of nasally intubating the brain in these situations. Has there been some documented evidence that it actually DOES and HAS happened that I missed in the last few years? If so, someone please share it with us. Jane Dinsmore To: texasems-l From: lnmolino@... Date: Thu, 6 May 2010 17:31:30 -0400 Subject: Re: Re: Airway Question So you're older are Ya bragging or complaining. Brand new as in NJ went to the 2nd Ed in mid 1981 so it could have been 20 years old it was new to us Also I think it was Brady or maybe a pre-Brady Publisher that in the same year as that did a Basic book with a set of color plates that were piloted in some places in NJ same time. we got a look at that and were all a gast at the color, it was so novel. Again new to NJ in 1981. Louis N. Molino, Sr., CET FF/NREMT-B/FSI/EMSI Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant LNMolino@... (Cell Phone) " A Texan with a Jersey Attitude " " Great minds discuss ideas; Average minds discuss events; Small minds discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) In a message dated 5/6/2010 4:09:26 P.M. Central Daylight Time, krin135@... writes: pardon, Sir, but the " Orange Book, Second Edition " was *at least* 6 years old by the time you took your -A course. I took my 81 hour -A course in 1976-7 with the Second Edition... and, IIRC, we were the second or third class at that training center to use it (St ph's Hospital Medical Center, Bloomington, IL). ck In a message dated 5/6/2010 16:03:43 Central Daylight Time, _lnmolino@..._ (mailto:lnmolino@...) writes: Part of the issue here is the 6th edition is a full 4 editions ago. Granted even me a Basic knew that nasal intubation was a NO NO in the case of a skull fracture. Oh my EMT-A course in 1981 was with the brand new AAOS 2nd Ed. Louis N. Molino, Sr., CET FF/NREMT-B/FSI/FF/N Freelance Consultant/Trainer/Freelance Consultant/Trainer/ Freelance __LNMolino (AT) aol (DOT) _LN_ (mailto:_LNMolino@...) _ (mailto:_LNMolino@..._ (mailto:LNMolino@...) ) (Cell Phone) " A Texan with a Jersey Attitude " " Great minds discuss ideas; Average minds discuss events; Small minds discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) In a message dated 5/6/2010 3:28:09 P.M. Central Daylight Time, __medic0946 (AT) yahoo (DOT) _me_ (mailto:_medic0946@...) _ (mailto:_medic0946@..._ (mailto:medic0946@...) ) writes: Rick, you were correct. Nasal intubation should be avoided in the possibility of basal skull fx. > > Ok group, > I normally do more reading than talking on here, but I have a question that is killing my brain, LoL. I'm studying for my NREMTP using the " Caroline's Emergency Care in the Streets 6th Edition " student workbook. > > Under the " Airway Management & Ventilation " chapter the question states, > > You have a 42 y/o female extricated from a wrecked vehicle; she is unconscious and has a depressed skull fracture at the back of her head. To secure an airway would you choose, > > A. Blind nasotracheal intubation as the preferred technique. > B. Tracheal intubation as the preferred technique. > C. Cricothyrotomy as the preferred technique. > > I chose " B' as my answer, and was told (by the answers in the back of the book) that the correct answer was " A " . Please correct me if I'm wrong as I am still learning, but have we not always been taught NOT to use nasotracheal intubation if the pt has a skull fracture of any kind? > > Everyones input will be greatly appreciated, because I really need to pass my test. > > Thanks, > R. > > Democracy will cease to exist when you take away from those who are willing to work and give to those who are not. > Jefferson > > > > > > [Non-text portions of this message have been removed] > [Non-text portions of this message have been removed] [Non-text portions of this message have been removed] [Non-text portions of this message have been removed] _________________________________________________________________ The New Busy think 9 to 5 is a cute idea. Combine multiple calendars with Hotmail. http://www.windowslive.com/campaign/thenewbusy?tile=multicalendar&ocid=PID28 326::T:WLMTAGL:ON:WL:en-US:WM_HMP:042010_5 [Non-text portions of this message have been removed] ------------------------------------ Yahoo! Groups Links Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2010 Report Share Posted May 6, 2010 actually, the BAAM 'whistle' is one of them- I learned NT intubation well before that was introduced, and having one's ear near an open tube when the patient coughs a big lugie out is NOT a pleasant experience. The other item is a good pair of Magill forceps... and maybe a Grandview blade... ck In a message dated 5/6/2010 17:43:37 Central Daylight Time, toni_crippen@... writes: LOL - because you need to hear the whistle from the BAAM. Two work-arounds? A chest compression? cric pressure? Do tell! From: _texasems-l@yahoogrotexasem_ (mailto:texasems-l ) [mailto:_texasems-l@yahoogrotexasem_ (mailto:texasems-l ) ] On Behalf Of _krin135@..._ (mailto:krin135@...) Sent: Thursday, May 06, 2010 5:27 PM To: _texasems-l@yahoogrotexasem_ (mailto:texasems-l ) Subject: Re: Re: Airway Question for extra credit, *why* is apnea a relative contraindication to nasal intubation and how can you work around it if you need to? Hint: there are two pieces of equipment that might make it possible.... ck In a message dated 5/6/2010 17:13:49 Central Daylight Time, _toni_crippen@toni_crippeton_ (mailto:toni_crippen@...) writes: Having recently graduated, I was taught facial fractures and apnea were the contraindications for nasal intubations. Toni [Non-text portions of this message have been removed] [Non-text portions of this message have been removed] Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2010 Report Share Posted May 6, 2010 of course, the 'trigger' type tubes (where there is a way to flex the tip of the tube, and the bevel is always at the outside of the curve) can also help blindly intubating a patient without obvious respirations. (nothing like hitting 'send' before completing the thought.) ck In a message dated 5/6/2010 17:52:31 Central Daylight Time, krin135@... writes: actually, the BAAM 'whistle' is one of them- I learned NT intubation well before that was introduced, and having one's ear near an open tube when the patient coughs a big lugie out is NOT a pleasant experience. The other item is a good pair of Magill forceps... and maybe a Grandview blade... ck In a message dated 5/6/2010 17:43:37 Central Daylight Time, _toni_crippen@toni_crippeton_ (mailto:toni_crippen@...) writes: LOL - because you need to hear the whistle from the BAAM. Two work-arounds? A chest compression? cric pressure? Do tell! From: _texasems-l@From: _texasems-l@ ya_texasems-l@yahoogrotexasem_ (mailto:texasems-l ) ) [mailto:_texasems-[mailto:_texasem[mailto:_te_texasems-l@yahoogrotexasem_ (mailto:texasems-l ) ) ] On Behalf Of __krin135 (AT) aol (DOT) _kr_ (mailto:_krin135@...) _ (mailto:_krin135@..._ (mailto:krin135@...) ) Sent: Thursday, May 06, 2010 5:27 PM To: _texasems-l@To: _texasems-l@ yaho_texasems-l@yahoogrotexasem_ (mailto:texasems-l ) ) Subject: Re: Re: Airway Question for extra credit, *why* is apnea a relative contraindication to nasal intubation and how can you work around it if you need to? Hint: there are two pieces of equipment that might make it possible.... ck In a message dated 5/6/2010 17:13:49 Central Daylight Time, _toni_crippen@_toni_crippen@ toni__toni_crippen@toni_crippeton_ (mailto:toni_crippen@...) ) writes: Having recently graduated, I was taught facial fractures and apnea were the contraindications for nasal intubations. Toni [Non-text portions of this message have been removed] [Non-text portions of this message have been removed] [Non-text portions of this message have been removed] Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2010 Report Share Posted May 6, 2010 You should never perform nasal intubation with any head injuries it is contraidicated especially with suspected skull fractures. ________________________________ To: texasems-l Sent: Thu, May 6, 2010 4:09:07 PM Subject: Re: Re: Airway Question  pardon, Sir, but the " Orange Book, Second Edition " was *at least* 6 years old by the time you took your -A course. I took my 81 hour -A course in 1976-7 with the Second Edition... and, IIRC, we were the second or third class at that training center to use it (St ph's Hospital Medical Center, Bloomington, IL). ck In a message dated 5/6/2010 16:03:43 Central Daylight Time, lnmolino (AT) aol (DOT) com writes: Part of the issue here is the 6th edition is a full 4 editions ago. Granted even me a Basic knew that nasal intubation was a NO NO in the case of a skull fracture. Oh my EMT-A course in 1981 was with the brand new AAOS 2nd Ed. Louis N. Molino, Sr., CET FF/NREMT-B/FSI/ FF/N Freelance Consultant/Trainer/ Freelance CoFreelance Consultant/Trainer _LNMolino (AT) aol (DOT) LNM_ (mailto:LNMolino (AT) aol (DOT) com) (Cell Phone) " A Texan with a Jersey Attitude " " Great minds discuss ideas; Average minds discuss events; Small minds discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) In a message dated 5/6/2010 3:28:09 P.M. Central Daylight Time, _medic0946 (AT) yahoo (DOT) med_ (mailto:medic0946 (AT) yahoo (DOT) com) writes: Rick, you were correct. Nasal intubation should be avoided in the possibility of basal skull fx. > > Ok group, > I normally do more reading than talking on here, but I have a question that is killing my brain, LoL. I'm studying for my NREMTP using the " Caroline's Emergency Care in the Streets 6th Edition " student workbook. > > Under the " Airway Management & Ventilation " chapter the question states, > > You have a 42 y/o female extricated from a wrecked vehicle; she is unconscious and has a depressed skull fracture at the back of her head. To secure an airway would you choose, > > A. Blind nasotracheal intubation as the preferred technique. > B. Tracheal intubation as the preferred technique. > C. Cricothyrotomy as the preferred technique. > > I chose " B' as my answer, and was told (by the answers in the back of the book) that the correct answer was " A " . Please correct me if I'm wrong as I am still learning, but have we not always been taught NOT to use nasotracheal intubation if the pt has a skull fracture of any kind? > > Everyones input will be greatly appreciated, because I really need to pass my test. > > Thanks, > R. > > Democracy will cease to exist when you take away from those who are willing to work and give to those who are not. > Jefferson > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2010 Report Share Posted May 6, 2010 You should never perform nasal intubation with any head injuries it is contraidicated especially with suspected skull fractures. ________________________________ To: texasems-l Sent: Thu, May 6, 2010 4:09:07 PM Subject: Re: Re: Airway Question  pardon, Sir, but the " Orange Book, Second Edition " was *at least* 6 years old by the time you took your -A course. I took my 81 hour -A course in 1976-7 with the Second Edition... and, IIRC, we were the second or third class at that training center to use it (St ph's Hospital Medical Center, Bloomington, IL). ck In a message dated 5/6/2010 16:03:43 Central Daylight Time, lnmolino (AT) aol (DOT) com writes: Part of the issue here is the 6th edition is a full 4 editions ago. Granted even me a Basic knew that nasal intubation was a NO NO in the case of a skull fracture. Oh my EMT-A course in 1981 was with the brand new AAOS 2nd Ed. Louis N. Molino, Sr., CET FF/NREMT-B/FSI/ FF/N Freelance Consultant/Trainer/ Freelance CoFreelance Consultant/Trainer _LNMolino (AT) aol (DOT) LNM_ (mailto:LNMolino (AT) aol (DOT) com) (Cell Phone) " A Texan with a Jersey Attitude " " Great minds discuss ideas; Average minds discuss events; Small minds discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) In a message dated 5/6/2010 3:28:09 P.M. Central Daylight Time, _medic0946 (AT) yahoo (DOT) med_ (mailto:medic0946 (AT) yahoo (DOT) com) writes: Rick, you were correct. Nasal intubation should be avoided in the possibility of basal skull fx. > > Ok group, > I normally do more reading than talking on here, but I have a question that is killing my brain, LoL. I'm studying for my NREMTP using the " Caroline's Emergency Care in the Streets 6th Edition " student workbook. > > Under the " Airway Management & Ventilation " chapter the question states, > > You have a 42 y/o female extricated from a wrecked vehicle; she is unconscious and has a depressed skull fracture at the back of her head. To secure an airway would you choose, > > A. Blind nasotracheal intubation as the preferred technique. > B. Tracheal intubation as the preferred technique. > C. Cricothyrotomy as the preferred technique. > > I chose " B' as my answer, and was told (by the answers in the back of the book) that the correct answer was " A " . Please correct me if I'm wrong as I am still learning, but have we not always been taught NOT to use nasotracheal intubation if the pt has a skull fracture of any kind? > > Everyones input will be greatly appreciated, because I really need to pass my test. > > Thanks, > R. > > Democracy will cease to exist when you take away from those who are willing to work and give to those who are not. > Jefferson > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2010 Report Share Posted May 6, 2010 You should never perform nasal intubation with any head injuries it is contraidicated especially with suspected skull fractures. ________________________________ To: texasems-l Sent: Thu, May 6, 2010 4:09:07 PM Subject: Re: Re: Airway Question  pardon, Sir, but the " Orange Book, Second Edition " was *at least* 6 years old by the time you took your -A course. I took my 81 hour -A course in 1976-7 with the Second Edition... and, IIRC, we were the second or third class at that training center to use it (St ph's Hospital Medical Center, Bloomington, IL). ck In a message dated 5/6/2010 16:03:43 Central Daylight Time, lnmolino (AT) aol (DOT) com writes: Part of the issue here is the 6th edition is a full 4 editions ago. Granted even me a Basic knew that nasal intubation was a NO NO in the case of a skull fracture. Oh my EMT-A course in 1981 was with the brand new AAOS 2nd Ed. Louis N. Molino, Sr., CET FF/NREMT-B/FSI/ FF/N Freelance Consultant/Trainer/ Freelance CoFreelance Consultant/Trainer _LNMolino (AT) aol (DOT) LNM_ (mailto:LNMolino (AT) aol (DOT) com) (Cell Phone) " A Texan with a Jersey Attitude " " Great minds discuss ideas; Average minds discuss events; Small minds discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) In a message dated 5/6/2010 3:28:09 P.M. Central Daylight Time, _medic0946 (AT) yahoo (DOT) med_ (mailto:medic0946 (AT) yahoo (DOT) com) writes: Rick, you were correct. Nasal intubation should be avoided in the possibility of basal skull fx. > > Ok group, > I normally do more reading than talking on here, but I have a question that is killing my brain, LoL. I'm studying for my NREMTP using the " Caroline's Emergency Care in the Streets 6th Edition " student workbook. > > Under the " Airway Management & Ventilation " chapter the question states, > > You have a 42 y/o female extricated from a wrecked vehicle; she is unconscious and has a depressed skull fracture at the back of her head. To secure an airway would you choose, > > A. Blind nasotracheal intubation as the preferred technique. > B. Tracheal intubation as the preferred technique. > C. Cricothyrotomy as the preferred technique. > > I chose " B' as my answer, and was told (by the answers in the back of the book) that the correct answer was " A " . Please correct me if I'm wrong as I am still learning, but have we not always been taught NOT to use nasotracheal intubation if the pt has a skull fracture of any kind? > > Everyones input will be greatly appreciated, because I really need to pass my test. > > Thanks, > R. > > Democracy will cease to exist when you take away from those who are willing to work and give to those who are not. > Jefferson > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2010 Report Share Posted May 6, 2010 I certianly would not want to take a chance on intubating the brain due to unknown fractures I would rather weight on the side of caution regardless of the studies. ________________________________ To: texasems-l Sent: Thu, May 6, 2010 5:06:21 PM Subject: RE: Re: Airway Question My understanding is that nasal intubation in head injuries has become a general consensus " moot point " as there have been no documented cases of nasally intubating the brain in these situations. Has there been some documented evidence that it actually DOES and HAS happened that I missed in the last few years? If so, someone please share it with us. Jane Dinsmore To: texasems-l From: lnmolino@... Date: Thu, 6 May 2010 17:31:30 -0400 Subject: Re: Re: Airway Question So you're older are Ya bragging or complaining. Brand new as in NJ went to the 2nd Ed in mid 1981 so it could have been 20 years old it was new to us Also I think it was Brady or maybe a pre-Brady Publisher that in the same year as that did a Basic book with a set of color plates that were piloted in some places in NJ same time. we got a look at that and were all a gast at the color, it was so novel. Again new to NJ in 1981. Louis N. Molino, Sr., CET FF/NREMT-B/FSI/EMSI Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant LNMolino@... (Cell Phone) " A Texan with a Jersey Attitude " " Great minds discuss ideas; Average minds discuss events; Small minds discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) In a message dated 5/6/2010 4:09:26 P.M. Central Daylight Time, krin135@... writes: pardon, Sir, but the " Orange Book, Second Edition " was *at least* 6 years old by the time you took your -A course. I took my 81 hour -A course in 1976-7 with the Second Edition... and, IIRC, we were the second or third class at that training center to use it (St ph's Hospital Medical Center, Bloomington, IL). ck In a message dated 5/6/2010 16:03:43 Central Daylight Time, _lnmolino@..._ (mailto:lnmolino@...) writes: Part of the issue here is the 6th edition is a full 4 editions ago. Granted even me a Basic knew that nasal intubation was a NO NO in the case of a skull fracture. Oh my EMT-A course in 1981 was with the brand new AAOS 2nd Ed. Louis N. Molino, Sr., CET FF/NREMT-B/FSI/FF/N Freelance Consultant/Trainer/Freelance Consultant/Trainer/ Freelance __LNMolino (AT) aol (DOT) _LN_ (mailto:_LNMolino@...) _ (mailto:_LNMolino@..._ (mailto:LNMolino@...) ) (Cell Phone) " A Texan with a Jersey Attitude " " Great minds discuss ideas; Average minds discuss events; Small minds discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) In a message dated 5/6/2010 3:28:09 P.M. Central Daylight Time, __medic0946 (AT) yahoo (DOT) _me_ (mailto:_medic0946@...) _ (mailto:_medic0946@..._ (mailto:medic0946@...) ) writes: Rick, you were correct. Nasal intubation should be avoided in the possibility of basal skull fx. > > Ok group, > I normally do more reading than talking on here, but I have a question that is killing my brain, LoL. I'm studying for my NREMTP using the " Caroline's Emergency Care in the Streets 6th Edition " student workbook. > > Under the " Airway Management & Ventilation " chapter the question states, > > You have a 42 y/o female extricated from a wrecked vehicle; she is unconscious and has a depressed skull fracture at the back of her head. To secure an airway would you choose, > > A. Blind nasotracheal intubation as the preferred technique. > B. Tracheal intubation as the preferred technique. > C. Cricothyrotomy as the preferred technique. > > I chose " B' as my answer, and was told (by the answers in the back of the book) that the correct answer was " A " . Please correct me if I'm wrong as I am still learning, but have we not always been taught NOT to use nasotracheal intubation if the pt has a skull fracture of any kind? > > Everyones input will be greatly appreciated, because I really need to pass my test. > > Thanks, > R. > > Democracy will cease to exist when you take away from those who are willing to work and give to those who are not. > Jefferson > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2010 Report Share Posted May 6, 2010 I certianly would not want to take a chance on intubating the brain due to unknown fractures I would rather weight on the side of caution regardless of the studies. ________________________________ To: texasems-l Sent: Thu, May 6, 2010 5:06:21 PM Subject: RE: Re: Airway Question My understanding is that nasal intubation in head injuries has become a general consensus " moot point " as there have been no documented cases of nasally intubating the brain in these situations. Has there been some documented evidence that it actually DOES and HAS happened that I missed in the last few years? If so, someone please share it with us. Jane Dinsmore To: texasems-l From: lnmolino@... Date: Thu, 6 May 2010 17:31:30 -0400 Subject: Re: Re: Airway Question So you're older are Ya bragging or complaining. Brand new as in NJ went to the 2nd Ed in mid 1981 so it could have been 20 years old it was new to us Also I think it was Brady or maybe a pre-Brady Publisher that in the same year as that did a Basic book with a set of color plates that were piloted in some places in NJ same time. we got a look at that and were all a gast at the color, it was so novel. Again new to NJ in 1981. Louis N. Molino, Sr., CET FF/NREMT-B/FSI/EMSI Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant LNMolino@... (Cell Phone) " A Texan with a Jersey Attitude " " Great minds discuss ideas; Average minds discuss events; Small minds discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) In a message dated 5/6/2010 4:09:26 P.M. Central Daylight Time, krin135@... writes: pardon, Sir, but the " Orange Book, Second Edition " was *at least* 6 years old by the time you took your -A course. I took my 81 hour -A course in 1976-7 with the Second Edition... and, IIRC, we were the second or third class at that training center to use it (St ph's Hospital Medical Center, Bloomington, IL). ck In a message dated 5/6/2010 16:03:43 Central Daylight Time, _lnmolino@..._ (mailto:lnmolino@...) writes: Part of the issue here is the 6th edition is a full 4 editions ago. Granted even me a Basic knew that nasal intubation was a NO NO in the case of a skull fracture. Oh my EMT-A course in 1981 was with the brand new AAOS 2nd Ed. Louis N. Molino, Sr., CET FF/NREMT-B/FSI/FF/N Freelance Consultant/Trainer/Freelance Consultant/Trainer/ Freelance __LNMolino (AT) aol (DOT) _LN_ (mailto:_LNMolino@...) _ (mailto:_LNMolino@..._ (mailto:LNMolino@...) ) (Cell Phone) " A Texan with a Jersey Attitude " " Great minds discuss ideas; Average minds discuss events; Small minds discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) In a message dated 5/6/2010 3:28:09 P.M. Central Daylight Time, __medic0946 (AT) yahoo (DOT) _me_ (mailto:_medic0946@...) _ (mailto:_medic0946@..._ (mailto:medic0946@...) ) writes: Rick, you were correct. Nasal intubation should be avoided in the possibility of basal skull fx. > > Ok group, > I normally do more reading than talking on here, but I have a question that is killing my brain, LoL. I'm studying for my NREMTP using the " Caroline's Emergency Care in the Streets 6th Edition " student workbook. > > Under the " Airway Management & Ventilation " chapter the question states, > > You have a 42 y/o female extricated from a wrecked vehicle; she is unconscious and has a depressed skull fracture at the back of her head. To secure an airway would you choose, > > A. Blind nasotracheal intubation as the preferred technique. > B. Tracheal intubation as the preferred technique. > C. Cricothyrotomy as the preferred technique. > > I chose " B' as my answer, and was told (by the answers in the back of the book) that the correct answer was " A " . Please correct me if I'm wrong as I am still learning, but have we not always been taught NOT to use nasotracheal intubation if the pt has a skull fracture of any kind? > > Everyones input will be greatly appreciated, because I really need to pass my test. > > Thanks, > R. > > Democracy will cease to exist when you take away from those who are willing to work and give to those who are not. > Jefferson > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2010 Report Share Posted May 6, 2010 I certianly would not want to take a chance on intubating the brain due to unknown fractures I would rather weight on the side of caution regardless of the studies. ________________________________ To: texasems-l Sent: Thu, May 6, 2010 5:06:21 PM Subject: RE: Re: Airway Question My understanding is that nasal intubation in head injuries has become a general consensus " moot point " as there have been no documented cases of nasally intubating the brain in these situations. Has there been some documented evidence that it actually DOES and HAS happened that I missed in the last few years? If so, someone please share it with us. Jane Dinsmore To: texasems-l From: lnmolino@... Date: Thu, 6 May 2010 17:31:30 -0400 Subject: Re: Re: Airway Question So you're older are Ya bragging or complaining. Brand new as in NJ went to the 2nd Ed in mid 1981 so it could have been 20 years old it was new to us Also I think it was Brady or maybe a pre-Brady Publisher that in the same year as that did a Basic book with a set of color plates that were piloted in some places in NJ same time. we got a look at that and were all a gast at the color, it was so novel. Again new to NJ in 1981. Louis N. Molino, Sr., CET FF/NREMT-B/FSI/EMSI Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant LNMolino@... (Cell Phone) " A Texan with a Jersey Attitude " " Great minds discuss ideas; Average minds discuss events; Small minds discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) In a message dated 5/6/2010 4:09:26 P.M. Central Daylight Time, krin135@... writes: pardon, Sir, but the " Orange Book, Second Edition " was *at least* 6 years old by the time you took your -A course. I took my 81 hour -A course in 1976-7 with the Second Edition... and, IIRC, we were the second or third class at that training center to use it (St ph's Hospital Medical Center, Bloomington, IL). ck In a message dated 5/6/2010 16:03:43 Central Daylight Time, _lnmolino@..._ (mailto:lnmolino@...) writes: Part of the issue here is the 6th edition is a full 4 editions ago. Granted even me a Basic knew that nasal intubation was a NO NO in the case of a skull fracture. Oh my EMT-A course in 1981 was with the brand new AAOS 2nd Ed. Louis N. Molino, Sr., CET FF/NREMT-B/FSI/FF/N Freelance Consultant/Trainer/Freelance Consultant/Trainer/ Freelance __LNMolino (AT) aol (DOT) _LN_ (mailto:_LNMolino@...) _ (mailto:_LNMolino@..._ (mailto:LNMolino@...) ) (Cell Phone) " A Texan with a Jersey Attitude " " Great minds discuss ideas; Average minds discuss events; Small minds discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) In a message dated 5/6/2010 3:28:09 P.M. Central Daylight Time, __medic0946 (AT) yahoo (DOT) _me_ (mailto:_medic0946@...) _ (mailto:_medic0946@..._ (mailto:medic0946@...) ) writes: Rick, you were correct. Nasal intubation should be avoided in the possibility of basal skull fx. > > Ok group, > I normally do more reading than talking on here, but I have a question that is killing my brain, LoL. I'm studying for my NREMTP using the " Caroline's Emergency Care in the Streets 6th Edition " student workbook. > > Under the " Airway Management & Ventilation " chapter the question states, > > You have a 42 y/o female extricated from a wrecked vehicle; she is unconscious and has a depressed skull fracture at the back of her head. To secure an airway would you choose, > > A. Blind nasotracheal intubation as the preferred technique. > B. Tracheal intubation as the preferred technique. > C. Cricothyrotomy as the preferred technique. > > I chose " B' as my answer, and was told (by the answers in the back of the book) that the correct answer was " A " . Please correct me if I'm wrong as I am still learning, but have we not always been taught NOT to use nasotracheal intubation if the pt has a skull fracture of any kind? > > Everyones input will be greatly appreciated, because I really need to pass my test. > > Thanks, > R. > > Democracy will cease to exist when you take away from those who are willing to work and give to those who are not. > Jefferson > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2010 Report Share Posted May 6, 2010 ck, Since I'm also a respiratory therapist, I'll let someone else get the extra credit. Lol - Sent via BlackBerry by AT&T Re: Re: Airway Question for extra credit, *why* is apnea a relative contraindication to nasal intubation and how can you work around it if you need to? Hint: there are two pieces of equipment that might make it possible.... ck In a message dated 5/6/2010 17:13:49 Central Daylight Time, toni_crippen@... writes: Having recently graduated, I was taught facial fractures and apnea were the contraindications for nasal intubations. Toni Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2010 Report Share Posted May 6, 2010 ck, Since I'm also a respiratory therapist, I'll let someone else get the extra credit. Lol - Sent via BlackBerry by AT&T Re: Re: Airway Question for extra credit, *why* is apnea a relative contraindication to nasal intubation and how can you work around it if you need to? Hint: there are two pieces of equipment that might make it possible.... ck In a message dated 5/6/2010 17:13:49 Central Daylight Time, toni_crippen@... writes: Having recently graduated, I was taught facial fractures and apnea were the contraindications for nasal intubations. Toni Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2010 Report Share Posted May 6, 2010 Unfortunately, we have continued to teach myth as fact over and over again until it even ends up in textbooks as fact. And since we are such a young profession with so little research to justify or negate so much of what we have set as standard of care. Jane Dinsmore To: texasems-l From: james_dav_bmcg@... Date: Thu, 6 May 2010 16:40:35 -0700 Subject: RE: Re: Airway Question agreed. at the conference last some doc from jpsh (ft. worth) said that " intracranial tube migration " was a myth.... jim davis paramedic Subject: RE: Re: Airway Question To: texasems-l Date: Thursday, May 6, 2010, 5:06 PM My understanding is that nasal intubation in head injuries has become a general consensus " moot point " as there have been no documented cases of nasally intubating the brain in these situations. Has there been some documented evidence that it actually DOES and HAS happened that I missed in the last few years? If so, someone please share it with us. Jane Dinsmore To: texasems-l From: lnmolino@... Date: Thu, 6 May 2010 17:31:30 -0400 Subject: Re: Re: Airway Question So you're older are Ya bragging or complaining. Brand new as in NJ went to the 2nd Ed in mid 1981 so it could have been 20 years old it was new to us Also I think it was Brady or maybe a pre-Brady Publisher that in the same year as that did a Basic book with a set of color plates that were piloted in some places in NJ same time. we got a look at that and were all a gast at the color, it was so novel. Again new to NJ in 1981. Louis N. Molino, Sr., CET FF/NREMT-B/FSI/EMSI Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant LNMolino@... (Cell Phone) " A Texan with a Jersey Attitude " " Great minds discuss ideas; Average minds discuss events; Small minds discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) In a message dated 5/6/2010 4:09:26 P.M. Central Daylight Time, krin135@... writes: pardon, Sir, but the " Orange Book, Second Edition " was *at least* 6 years old by the time you took your -A course. I took my 81 hour -A course in 1976-7 with the Second Edition... and, IIRC, we were the second or third class at that training center to use it (St ph's Hospital Medical Center, Bloomington, IL). ck In a message dated 5/6/2010 16:03:43 Central Daylight Time, _lnmolino@..._ (mailto:lnmolino@...) writes: Part of the issue here is the 6th edition is a full 4 editions ago. Granted even me a Basic knew that nasal intubation was a NO NO in the case of a skull fracture. Oh my EMT-A course in 1981 was with the brand new AAOS 2nd Ed. Louis N. Molino, Sr., CET FF/NREMT-B/FSI/FF/N Freelance Consultant/Trainer/Freelance Consultant/Trainer/ Freelance __LNMolino (AT) aol (DOT) _LN_ (mailto:_LNMolino@...) _ (mailto:_LNMolino@..._ (mailto:LNMolino@...) ) (Cell Phone) " A Texan with a Jersey Attitude " " Great minds discuss ideas; Average minds discuss events; Small minds discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) In a message dated 5/6/2010 3:28:09 P.M. Central Daylight Time, __medic0946 (AT) yahoo (DOT) _me_ (mailto:_medic0946@...) _ (mailto:_medic0946@..._ (mailto:medic0946@...) ) writes: Rick, you were correct. Nasal intubation should be avoided in the possibility of basal skull fx. > > Ok group, > I normally do more reading than talking on here, but I have a question that is killing my brain, LoL. I'm studying for my NREMTP using the " Caroline's Emergency Care in the Streets 6th Edition " student workbook. > > Under the " Airway Management & Ventilation " chapter the question states, > > You have a 42 y/o female extricated from a wrecked vehicle; she is unconscious and has a depressed skull fracture at the back of her head. To secure an airway would you choose, > > A. Blind nasotracheal intubation as the preferred technique. > B. Tracheal intubation as the preferred technique. > C. Cricothyrotomy as the preferred technique. > > I chose " B' as my answer, and was told (by the answers in the back of the book) that the correct answer was " A " . Please correct me if I'm wrong as I am still learning, but have we not always been taught NOT to use nasotracheal intubation if the pt has a skull fracture of any kind? > > Everyones input will be greatly appreciated, because I really need to pass my test. > > Thanks, > R. > > Democracy will cease to exist when you take away from those who are willing to work and give to those who are not. > Jefferson > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2010 Report Share Posted May 6, 2010 Doc: I was searching for this pic on Google to see if it showed up. I saw it as part of a class in the 90's. It looked like a tapeworm. Steve From: texasems-l [mailto:texasems-l ] On Behalf Of krin135@... Sent: Thursday, May 06, 2010 5:25 PM To: texasems-l Subject: Re: Re: Airway Question I do not recall any ET tubes through the base of the skull, but I do recall a couple of NGs that showed up as coiled in the cranium when I was in medical school years ago. ck In a message dated 5/6/2010 17:06:34 Central Daylight Time, texas.paramedic@... writes: My understanding is that nasal intubation in head injuries has become a general consensus " moot point " as there have been no documented cases of nasally intubating the brain in these situations. Has there been some documented evidence that it actually DOES and HAS happened that I missed in the last few years? If so, someone please share it with us. Jane Dinsmore To: texasems-l From: lnmolino@... Date: Thu, 6 May 2010 17:31:30 -0400 Subject: Re: Re: Airway Question So you're older are Ya bragging or complaining. Brand new as in NJ went to the 2nd Ed in mid 1981 so it could have been 20 years old it was new to us Also I think it was Brady or maybe a pre-Brady Publisher that in the same year as that did a Basic book with a set of color plates that were piloted in some places in NJ same time. we got a look at that and were all a gast at the color, it was so novel. Again new to NJ in 1981. Louis N. Molino, Sr., CET FF/NREMT-B/FSI/EMSI Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant LNMolino@... (Cell Phone) " A Texan with a Jersey Attitude " " Great minds discuss ideas; Average minds discuss events; Small minds discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) In a message dated 5/6/2010 4:09:26 P.M. Central Daylight Time, krin135@... writes: pardon, Sir, but the " Orange Book, Second Edition " was *at least* 6 years old by the time you took your -A course. I took my 81 hour -A course in 1976-7 with the Second Edition... and, IIRC, we were the second or third class at that training center to use it (St ph's Hospital Medical Center, Bloomington, IL). ck In a message dated 5/6/2010 16:03:43 Central Daylight Time, _lnmolino@... _ (mailto:lnmolino@... ) writes: Part of the issue here is the 6th edition is a full 4 editions ago. Granted even me a Basic knew that nasal intubation was a NO NO in the case of a skull fracture. Oh my EMT-A course in 1981 was with the brand new AAOS 2nd Ed. Louis N. Molino, Sr., CET FF/NREMT-B/FSI/FF/N Freelance Consultant/Trainer/Freelance Consultant/Trainer/ Freelance __LNMolino (AT) aol (DOT) _LN_ (mailto:_LNMolino@... ) _ (mailto:_LNMolino@... _ (mailto:LNMolino@... ) ) (Cell Phone) " A Texan with a Jersey Attitude " " Great minds discuss ideas; Average minds discuss events; Small minds discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) In a message dated 5/6/2010 3:28:09 P.M. Central Daylight Time, __medic0946 (AT) yahoo (DOT) _me_ (mailto:_medic0946@... ) _ (mailto:_medic0946@... _ (mailto:medic0946@... ) ) writes: Rick, you were correct. Nasal intubation should be avoided in the possibility of basal skull fx. > > Ok group, > I normally do more reading than talking on here, but I have a question that is killing my brain, LoL. I'm studying for my NREMTP using the " Caroline's Emergency Care in the Streets 6th Edition " student workbook. > > Under the " Airway Management & Ventilation " chapter the question states, > > You have a 42 y/o female extricated from a wrecked vehicle; she is unconscious and has a depressed skull fracture at the back of her head. To secure an airway would you choose, > > A. Blind nasotracheal intubation as the preferred technique. > B. Tracheal intubation as the preferred technique. > C. Cricothyrotomy as the preferred technique. > > I chose " B' as my answer, and was told (by the answers in the back of the book) that the correct answer was " A " . Please correct me if I'm wrong as I am still learning, but have we not always been taught NOT to use nasotracheal intubation if the pt has a skull fracture of any kind? > > Everyones input will be greatly appreciated, because I really need to pass my test. > > Thanks, > R. > > Democracy will cease to exist when you take away from those who are willing to work and give to those who are not. > Jefferson > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2010 Report Share Posted May 6, 2010 Doc: I was searching for this pic on Google to see if it showed up. I saw it as part of a class in the 90's. It looked like a tapeworm. Steve From: texasems-l [mailto:texasems-l ] On Behalf Of krin135@... Sent: Thursday, May 06, 2010 5:25 PM To: texasems-l Subject: Re: Re: Airway Question I do not recall any ET tubes through the base of the skull, but I do recall a couple of NGs that showed up as coiled in the cranium when I was in medical school years ago. ck In a message dated 5/6/2010 17:06:34 Central Daylight Time, texas.paramedic@... writes: My understanding is that nasal intubation in head injuries has become a general consensus " moot point " as there have been no documented cases of nasally intubating the brain in these situations. Has there been some documented evidence that it actually DOES and HAS happened that I missed in the last few years? If so, someone please share it with us. Jane Dinsmore To: texasems-l From: lnmolino@... Date: Thu, 6 May 2010 17:31:30 -0400 Subject: Re: Re: Airway Question So you're older are Ya bragging or complaining. Brand new as in NJ went to the 2nd Ed in mid 1981 so it could have been 20 years old it was new to us Also I think it was Brady or maybe a pre-Brady Publisher that in the same year as that did a Basic book with a set of color plates that were piloted in some places in NJ same time. we got a look at that and were all a gast at the color, it was so novel. Again new to NJ in 1981. Louis N. Molino, Sr., CET FF/NREMT-B/FSI/EMSI Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant LNMolino@... (Cell Phone) " A Texan with a Jersey Attitude " " Great minds discuss ideas; Average minds discuss events; Small minds discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) In a message dated 5/6/2010 4:09:26 P.M. Central Daylight Time, krin135@... writes: pardon, Sir, but the " Orange Book, Second Edition " was *at least* 6 years old by the time you took your -A course. I took my 81 hour -A course in 1976-7 with the Second Edition... and, IIRC, we were the second or third class at that training center to use it (St ph's Hospital Medical Center, Bloomington, IL). ck In a message dated 5/6/2010 16:03:43 Central Daylight Time, _lnmolino@... _ (mailto:lnmolino@... ) writes: Part of the issue here is the 6th edition is a full 4 editions ago. Granted even me a Basic knew that nasal intubation was a NO NO in the case of a skull fracture. Oh my EMT-A course in 1981 was with the brand new AAOS 2nd Ed. Louis N. Molino, Sr., CET FF/NREMT-B/FSI/FF/N Freelance Consultant/Trainer/Freelance Consultant/Trainer/ Freelance __LNMolino (AT) aol (DOT) _LN_ (mailto:_LNMolino@... ) _ (mailto:_LNMolino@... _ (mailto:LNMolino@... ) ) (Cell Phone) " A Texan with a Jersey Attitude " " Great minds discuss ideas; Average minds discuss events; Small minds discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) In a message dated 5/6/2010 3:28:09 P.M. Central Daylight Time, __medic0946 (AT) yahoo (DOT) _me_ (mailto:_medic0946@... ) _ (mailto:_medic0946@... _ (mailto:medic0946@... ) ) writes: Rick, you were correct. Nasal intubation should be avoided in the possibility of basal skull fx. > > Ok group, > I normally do more reading than talking on here, but I have a question that is killing my brain, LoL. I'm studying for my NREMTP using the " Caroline's Emergency Care in the Streets 6th Edition " student workbook. > > Under the " Airway Management & Ventilation " chapter the question states, > > You have a 42 y/o female extricated from a wrecked vehicle; she is unconscious and has a depressed skull fracture at the back of her head. To secure an airway would you choose, > > A. Blind nasotracheal intubation as the preferred technique. > B. Tracheal intubation as the preferred technique. > C. Cricothyrotomy as the preferred technique. > > I chose " B' as my answer, and was told (by the answers in the back of the book) that the correct answer was " A " . Please correct me if I'm wrong as I am still learning, but have we not always been taught NOT to use nasotracheal intubation if the pt has a skull fracture of any kind? > > Everyones input will be greatly appreciated, because I really need to pass my test. > > Thanks, > R. > > Democracy will cease to exist when you take away from those who are willing to work and give to those who are not. > Jefferson > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2010 Report Share Posted May 6, 2010 Doc: I was searching for this pic on Google to see if it showed up. I saw it as part of a class in the 90's. It looked like a tapeworm. Steve From: texasems-l [mailto:texasems-l ] On Behalf Of krin135@... Sent: Thursday, May 06, 2010 5:25 PM To: texasems-l Subject: Re: Re: Airway Question I do not recall any ET tubes through the base of the skull, but I do recall a couple of NGs that showed up as coiled in the cranium when I was in medical school years ago. ck In a message dated 5/6/2010 17:06:34 Central Daylight Time, texas.paramedic@... writes: My understanding is that nasal intubation in head injuries has become a general consensus " moot point " as there have been no documented cases of nasally intubating the brain in these situations. Has there been some documented evidence that it actually DOES and HAS happened that I missed in the last few years? If so, someone please share it with us. Jane Dinsmore To: texasems-l From: lnmolino@... Date: Thu, 6 May 2010 17:31:30 -0400 Subject: Re: Re: Airway Question So you're older are Ya bragging or complaining. Brand new as in NJ went to the 2nd Ed in mid 1981 so it could have been 20 years old it was new to us Also I think it was Brady or maybe a pre-Brady Publisher that in the same year as that did a Basic book with a set of color plates that were piloted in some places in NJ same time. we got a look at that and were all a gast at the color, it was so novel. Again new to NJ in 1981. Louis N. Molino, Sr., CET FF/NREMT-B/FSI/EMSI Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant LNMolino@... (Cell Phone) " A Texan with a Jersey Attitude " " Great minds discuss ideas; Average minds discuss events; Small minds discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) In a message dated 5/6/2010 4:09:26 P.M. Central Daylight Time, krin135@... writes: pardon, Sir, but the " Orange Book, Second Edition " was *at least* 6 years old by the time you took your -A course. I took my 81 hour -A course in 1976-7 with the Second Edition... and, IIRC, we were the second or third class at that training center to use it (St ph's Hospital Medical Center, Bloomington, IL). ck In a message dated 5/6/2010 16:03:43 Central Daylight Time, _lnmolino@... _ (mailto:lnmolino@... ) writes: Part of the issue here is the 6th edition is a full 4 editions ago. Granted even me a Basic knew that nasal intubation was a NO NO in the case of a skull fracture. Oh my EMT-A course in 1981 was with the brand new AAOS 2nd Ed. Louis N. Molino, Sr., CET FF/NREMT-B/FSI/FF/N Freelance Consultant/Trainer/Freelance Consultant/Trainer/ Freelance __LNMolino (AT) aol (DOT) _LN_ (mailto:_LNMolino@... ) _ (mailto:_LNMolino@... _ (mailto:LNMolino@... ) ) (Cell Phone) " A Texan with a Jersey Attitude " " Great minds discuss ideas; Average minds discuss events; Small minds discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) In a message dated 5/6/2010 3:28:09 P.M. Central Daylight Time, __medic0946 (AT) yahoo (DOT) _me_ (mailto:_medic0946@... ) _ (mailto:_medic0946@... _ (mailto:medic0946@... ) ) writes: Rick, you were correct. Nasal intubation should be avoided in the possibility of basal skull fx. > > Ok group, > I normally do more reading than talking on here, but I have a question that is killing my brain, LoL. I'm studying for my NREMTP using the " Caroline's Emergency Care in the Streets 6th Edition " student workbook. > > Under the " Airway Management & Ventilation " chapter the question states, > > You have a 42 y/o female extricated from a wrecked vehicle; she is unconscious and has a depressed skull fracture at the back of her head. To secure an airway would you choose, > > A. Blind nasotracheal intubation as the preferred technique. > B. Tracheal intubation as the preferred technique. > C. Cricothyrotomy as the preferred technique. > > I chose " B' as my answer, and was told (by the answers in the back of the book) that the correct answer was " A " . Please correct me if I'm wrong as I am still learning, but have we not always been taught NOT to use nasotracheal intubation if the pt has a skull fracture of any kind? > > Everyones input will be greatly appreciated, because I really need to pass my test. > > Thanks, > R. > > Democracy will cease to exist when you take away from those who are willing to work and give to those who are not. > Jefferson > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 7, 2010 Report Share Posted May 7, 2010 Right, Jane, And the worst thing about it is that people who could change the way we approach EMS education are asleep at the wheel. Here in AZ, I find that there is so much resistance to change that it's demoralizing. The folks who perpetuate these myths are: Nurses and Doctors who run the systems and the education programs. What we lack are leaders from our own discipline. This is not so much the case in Texas, but I'll cite this as being something you never want to happen in Texas. Here, the people who run EMS are " prehospital cordinator nurses " who work for the base hospitals that every service is forced to be affiliated with by rule, and a bunch of old docs who have run EMS forever. These docs have a plethora of initials after their names, and they are faculty at the medical school, but they haven't had a new thought in eons. There are no paramedic leaders that I have been able to identify, nor have I found any who have sought to be leaders. Paramedics are not teaching in the community college programs unless they're nurses also, and most of those have little or no field experience. They identify themselves as nurses, not paramedics. The paramedics, being fire department employees, with fire department benefits, and so forth, simply are not interested in doing anything on their off days to improve paramedic practice. If you ask them how they identify, it's firefighter, not paramedic. Switch to Texas. In Texas Paramedics have led the way in change, improved regulation, and have exerted plenty of pressure for change and improvement. But many of those paramedics are now dinosaurs like me. Who will the leaders of tomorrow be? There is tremendous opportunity for leaders to emerge. But it takes more than a " ho-hum " attitude. I could go on and on, but I'll spare you. Gene Re: Re: Airway Question So you're older are Ya bragging or complaining. Brand new as in NJ went to the 2nd Ed in mid 1981 so it could have been 20 years old it was new to us Also I think it was Brady or maybe a pre-Brady Publisher that in the same year as that did a Basic book with a set of color plates that were piloted in some places in NJ same time. we got a look at that and were all a gast at the color, it was so novel. Again new to NJ in 1981. Louis N. Molino, Sr., CET FF/NREMT-B/FSI/EMSI Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant LNMolino@... (Cell Phone) " A Texan with a Jersey Attitude " " Great minds discuss ideas; Average minds discuss events; Small minds discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) In a message dated 5/6/2010 4:09:26 P.M. Central Daylight Time, krin135@... writes: pardon, Sir, but the " Orange Book, Second Edition " was *at least* 6 years old by the time you took your -A course. I took my 81 hour -A course in 1976-7 with the Second Edition... and, IIRC, we were the second or third class at that training center to use it (St ph's Hospital Medical Center, Bloomington, IL). ck In a message dated 5/6/2010 16:03:43 Central Daylight Time, _lnmolino@..._ (mailto:lnmolino@...) writes: Part of the issue here is the 6th edition is a full 4 editions ago. Granted even me a Basic knew that nasal intubation was a NO NO in the case of a skull fracture. Oh my EMT-A course in 1981 was with the brand new AAOS 2nd Ed. Louis N. Molino, Sr., CET FF/NREMT-B/FSI/FF/N Freelance Consultant/Trainer/Freelance Consultant/Trainer/ Freelance __LNMolino (AT) aol (DOT) _LN_ (mailto:_LNMolino@...) _ (mailto:_LNMolino@..._ (mailto:LNMolino@...) ) (Cell Phone) " A Texan with a Jersey Attitude " " Great minds discuss ideas; Average minds discuss events; Small minds discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) In a message dated 5/6/2010 3:28:09 P.M. Central Daylight Time, __medic0946 (AT) yahoo (DOT) _me_ (mailto:_medic0946@...) _ (mailto:_medic0946@..._ (mailto:medic0946@...) ) writes: Rick, you were correct. Nasal intubation should be avoided in the possibility of basal skull fx. > > Ok group, > I normally do more reading than talking on here, but I have a question that is killing my brain, LoL. I'm studying for my NREMTP using the " Caroline's Emergency Care in the Streets 6th Edition " student workbook. > > Under the " Airway Management & Ventilation " chapter the question states, > > You have a 42 y/o female extricated from a wrecked vehicle; she is unconscious and has a depressed skull fracture at the back of her head. To secure an airway would you choose, > > A. Blind nasotracheal intubation as the preferred technique. > B. Tracheal intubation as the preferred technique. > C. Cricothyrotomy as the preferred technique. > > I chose " B' as my answer, and was told (by the answers in the back of the book) that the correct answer was " A " . Please correct me if I'm wrong as I am still learning, but have we not always been taught NOT to use nasotracheal intubation if the pt has a skull fracture of any kind? > > Everyones input will be greatly appreciated, because I really need to pass my test. > > Thanks, > R. > > Democracy will cease to exist when you take away from those who are willing to work and give to those who are not. > Jefferson > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 7, 2010 Report Share Posted May 7, 2010 Right, Jane, And the worst thing about it is that people who could change the way we approach EMS education are asleep at the wheel. Here in AZ, I find that there is so much resistance to change that it's demoralizing. The folks who perpetuate these myths are: Nurses and Doctors who run the systems and the education programs. What we lack are leaders from our own discipline. This is not so much the case in Texas, but I'll cite this as being something you never want to happen in Texas. Here, the people who run EMS are " prehospital cordinator nurses " who work for the base hospitals that every service is forced to be affiliated with by rule, and a bunch of old docs who have run EMS forever. These docs have a plethora of initials after their names, and they are faculty at the medical school, but they haven't had a new thought in eons. There are no paramedic leaders that I have been able to identify, nor have I found any who have sought to be leaders. Paramedics are not teaching in the community college programs unless they're nurses also, and most of those have little or no field experience. They identify themselves as nurses, not paramedics. The paramedics, being fire department employees, with fire department benefits, and so forth, simply are not interested in doing anything on their off days to improve paramedic practice. If you ask them how they identify, it's firefighter, not paramedic. Switch to Texas. In Texas Paramedics have led the way in change, improved regulation, and have exerted plenty of pressure for change and improvement. But many of those paramedics are now dinosaurs like me. Who will the leaders of tomorrow be? There is tremendous opportunity for leaders to emerge. But it takes more than a " ho-hum " attitude. I could go on and on, but I'll spare you. Gene Re: Re: Airway Question So you're older are Ya bragging or complaining. Brand new as in NJ went to the 2nd Ed in mid 1981 so it could have been 20 years old it was new to us Also I think it was Brady or maybe a pre-Brady Publisher that in the same year as that did a Basic book with a set of color plates that were piloted in some places in NJ same time. we got a look at that and were all a gast at the color, it was so novel. Again new to NJ in 1981. Louis N. Molino, Sr., CET FF/NREMT-B/FSI/EMSI Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant LNMolino@... (Cell Phone) " A Texan with a Jersey Attitude " " Great minds discuss ideas; Average minds discuss events; Small minds discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) In a message dated 5/6/2010 4:09:26 P.M. Central Daylight Time, krin135@... writes: pardon, Sir, but the " Orange Book, Second Edition " was *at least* 6 years old by the time you took your -A course. I took my 81 hour -A course in 1976-7 with the Second Edition... and, IIRC, we were the second or third class at that training center to use it (St ph's Hospital Medical Center, Bloomington, IL). ck In a message dated 5/6/2010 16:03:43 Central Daylight Time, _lnmolino@..._ (mailto:lnmolino@...) writes: Part of the issue here is the 6th edition is a full 4 editions ago. Granted even me a Basic knew that nasal intubation was a NO NO in the case of a skull fracture. Oh my EMT-A course in 1981 was with the brand new AAOS 2nd Ed. Louis N. Molino, Sr., CET FF/NREMT-B/FSI/FF/N Freelance Consultant/Trainer/Freelance Consultant/Trainer/ Freelance __LNMolino (AT) aol (DOT) _LN_ (mailto:_LNMolino@...) _ (mailto:_LNMolino@..._ (mailto:LNMolino@...) ) (Cell Phone) " A Texan with a Jersey Attitude " " Great minds discuss ideas; Average minds discuss events; Small minds discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) In a message dated 5/6/2010 3:28:09 P.M. Central Daylight Time, __medic0946 (AT) yahoo (DOT) _me_ (mailto:_medic0946@...) _ (mailto:_medic0946@..._ (mailto:medic0946@...) ) writes: Rick, you were correct. Nasal intubation should be avoided in the possibility of basal skull fx. > > Ok group, > I normally do more reading than talking on here, but I have a question that is killing my brain, LoL. I'm studying for my NREMTP using the " Caroline's Emergency Care in the Streets 6th Edition " student workbook. > > Under the " Airway Management & Ventilation " chapter the question states, > > You have a 42 y/o female extricated from a wrecked vehicle; she is unconscious and has a depressed skull fracture at the back of her head. To secure an airway would you choose, > > A. Blind nasotracheal intubation as the preferred technique. > B. Tracheal intubation as the preferred technique. > C. Cricothyrotomy as the preferred technique. > > I chose " B' as my answer, and was told (by the answers in the back of the book) that the correct answer was " A " . Please correct me if I'm wrong as I am still learning, but have we not always been taught NOT to use nasotracheal intubation if the pt has a skull fracture of any kind? > > Everyones input will be greatly appreciated, because I really need to pass my test. > > Thanks, > R. > > Democracy will cease to exist when you take away from those who are willing to work and give to those who are not. > Jefferson > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 8, 2010 Report Share Posted May 8, 2010 If the mouth is full of brains makes it much easier to oxygenate the grey matter.... Dudley Re: Re: Airway Question > > So you're older are Ya bragging or complaining. > > Brand new as in NJ went to the 2nd Ed in mid 1981 so it could have > been 20 > years old it was new to us > > Also I think it was Brady or maybe a pre-Brady Publisher that in the same > year as that did a Basic book with a set of color plates that were > piloted > in some places in NJ same time. we got a look at that and were all a > gast at > the color, it was so novel. Again new to NJ in 1981. > > Louis N. Molino, Sr., CET > FF/NREMT-B/FSI/EMSI > Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant > > LNMolino@... > > (Cell Phone) > > " A Texan with a Jersey Attitude " > > " Great minds discuss ideas; Average minds discuss events; Small minds > discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) > > In a message dated 5/6/2010 4:09:26 P.M. Central Daylight Time, > krin135@... writes: > > pardon, Sir, but the " Orange Book, Second Edition " was *at least* 6 years > old by the time you took your -A course. > > I took my 81 hour -A course in 1976-7 with the Second Edition... and, > IIRC, > we were the second or third class at that training center to use it (St > ph's Hospital Medical Center, Bloomington, IL). > > ck > > In a message dated 5/6/2010 16:03:43 Central Daylight Time, > _lnmolino@... _ > (mailto:lnmolino@... ) writes: > > Part of the issue here is the 6th edition is a full 4 editions ago. > > Granted even me a Basic knew that nasal intubation was a NO NO in the > case > of a skull fracture. > > Oh my EMT-A course in 1981 was with the brand new AAOS 2nd Ed. > > Louis N. Molino, Sr., CET > FF/NREMT-B/FSI/FF/N > Freelance Consultant/Trainer/Freelance Consultant/Trainer/ Freelance > > __LNMolino (AT) aol (DOT) _LN_ (mailto:_LNMolino@... > ) _ (mailto:_LNMolino@... > _ > (mailto:LNMolino@... ) ) > > (Cell Phone) > > " A Texan with a Jersey Attitude " > > " Great minds discuss ideas; Average minds discuss events; Small minds > discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) > > In a message dated 5/6/2010 3:28:09 P.M. Central Daylight Time, > __medic0946 (AT) yahoo (DOT) _me_ (mailto:_medic0946@... > ) _ > (mailto:_medic0946@... _ > (mailto:medic0946@... ) ) writes: > > Rick, you were correct. Nasal intubation should be avoided in the > possibility of basal skull fx. > > > > > > Ok group, > > I normally do more reading than talking on here, but I have a question > that is killing my brain, LoL. I'm studying for my NREMTP using the > " > Caroline's Emergency Care in the Streets 6th Edition " student workbook. > > > > Under the " Airway Management & Ventilation " chapter the question > states, > > > > You have a 42 y/o female extricated from a wrecked vehicle; she is > unconscious and has a depressed skull fracture at the back of her > head. To > secure an airway would you choose, > > > > A. Blind nasotracheal intubation as the preferred technique. > > B. Tracheal intubation as the preferred technique. > > C. Cricothyrotomy as the preferred technique. > > > > I chose " B' as my answer, and was told (by the answers in the back of > the book) that the correct answer was " A " . Please correct me if I'm wrong > as > I am still learning, but have we not always been taught NOT to use > nasotracheal intubation if the pt has a skull fracture of any kind? > > > > Everyones input will be greatly appreciated, because I really need to > pass my test. > > > > Thanks, > > R. > > > > Democracy will cease to exist when you take away from those who are > willing to work and give to those who are not. > > Jefferson > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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