Airway Question

May 6, 2010

Point of order! I believe he was talking about Emergency Care in the Streets,

6th edition, which was published in 2008.

Now, all this is nonsense, since the question is unanswerable. As several have

said, the traditional thinking has been not to insert anything in the nose,

neither an ET tube or a NG tube, if the patient might have a basilar skull

fracture. This myth apparently developed from ONE x-ray that got published in a

few places about 30 years ago. Nobody has ever been able to produce another one

that I know of. If you know of such a case please let us all know.

In fact, the chances of a cranial intubation from a skill fracture are remote

indeed. Yet this particular bit of mythology hangs on.

The " hook " in the Caroline question is that the fictional patient has a

" depressed skull fracture at the back of her head. " That's on the opposite side

of the head from one of the sinuses, which are the alleged site of the phantom

ET/NG tube cranial intubation.

The truth is, however, that without x-rays and CTs it is impossible to know

about all possible fractures to the cranium.

Therefore, the safe answer would be to insert a supraglottic airway, which is

what anybody capable of rational thinking and a rudimentary understanding of

airway care would do under the circumstances.

Beware of workbook questions in ANY workbook that goes with a text. I haven't

found ONE that didn't have quite a significant number of questionablely

formulated items. When something doesn't look right to you, seek further

insight.

And remember that the NREMT-P exam is not rational in any way. It's a " gotcha! "

exam that bears little or no relationship to real paramedic practice, regardless

of its boasts about task surveys and so forth.

Thank you for affording me this opportunity to make you quake in terror! Get

Rahm's book and study it, review the National Standard Curriculum, and

you'll do fine.

Best,

Gene

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@... 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@..._ (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@..._ (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]

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

>

May 7, 2010

Why, Kelton?

Based upon what scientific evidence? I submit that this is an EMS myth that has

been promulgated by a lot of folks who ought to know better, including the

authors of the current texts.

Fine me ONE valid study that supports this myth.

GG

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

>

May 7, 2010

Why, Kelton?

Based upon what scientific evidence? I submit that this is an EMS myth that has

been promulgated by a lot of folks who ought to know better, including the

authors of the current texts.

Fine me ONE valid study that supports this myth.

GG

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

>

May 7, 2010

Why, Kelton?

Based upon what scientific evidence? I submit that this is an EMS myth that has

been promulgated by a lot of folks who ought to know better, including the

authors of the current texts.

Fine me ONE valid study that supports this myth.

GG

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

>

May 7, 2010

Well, I wouldn't either, but there's just no evidence of that happening. It's

an EMS myth. And if you are concerned, just don't do it, and put in a

supraglottic airway. Simple.

You say something that's awfully disturbing. You say that you'd do something

" regardless of the studies. " Stop and think what you've said. You've said the

equivalent of " I believe in fairies. " Damn the studies. We're going to do what

we've always done regardless of facts.

Not good, my friend. Not good. The things that's most wrong with EMS right now

is that we are doing things unsupported by medical evidence. To say that you'll

ignore the studies just shows that you're not ready for prime time paramedicine.

I can think of a thousand things that MIGHT happen, but never have. Crainial

intubation is one of those.

I respect you, Kelton, and I am NOT bashing you. I'm just encouraging you to

seek truth rather than myth. Learn the anatomy and the mechanisms of injury

that occur. Read the literature. Get away from the Paramedic texts which are,

at best only the tip of the iceberg in medicine. If you only know what the

paramedic texts teach, you're a dumb paramedic.

When you do, you'll find that nobody who practices serious medicine believes the

ET tube cranial intubation myth. Don't be a Bozo.

Be smart. Seek truth.

Gene G.

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

>

May 7, 2010

Well, I wouldn't either, but there's just no evidence of that happening. It's

an EMS myth. And if you are concerned, just don't do it, and put in a

supraglottic airway. Simple.

You say something that's awfully disturbing. You say that you'd do something

" regardless of the studies. " Stop and think what you've said. You've said the

equivalent of " I believe in fairies. " Damn the studies. We're going to do what

we've always done regardless of facts.

Not good, my friend. Not good. The things that's most wrong with EMS right now

is that we are doing things unsupported by medical evidence. To say that you'll

ignore the studies just shows that you're not ready for prime time paramedicine.

I can think of a thousand things that MIGHT happen, but never have. Crainial

intubation is one of those.

I respect you, Kelton, and I am NOT bashing you. I'm just encouraging you to

seek truth rather than myth. Learn the anatomy and the mechanisms of injury

that occur. Read the literature. Get away from the Paramedic texts which are,

at best only the tip of the iceberg in medicine. If you only know what the

paramedic texts teach, you're a dumb paramedic.

When you do, you'll find that nobody who practices serious medicine believes the

ET tube cranial intubation myth. Don't be a Bozo.

Be smart. Seek truth.

Gene G.

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

>

May 7, 2010

Well, I wouldn't either, but there's just no evidence of that happening. It's

an EMS myth. And if you are concerned, just don't do it, and put in a

supraglottic airway. Simple.

You say something that's awfully disturbing. You say that you'd do something

" regardless of the studies. " Stop and think what you've said. You've said the

equivalent of " I believe in fairies. " Damn the studies. We're going to do what

we've always done regardless of facts.

Not good, my friend. Not good. The things that's most wrong with EMS right now

is that we are doing things unsupported by medical evidence. To say that you'll

ignore the studies just shows that you're not ready for prime time paramedicine.

I can think of a thousand things that MIGHT happen, but never have. Crainial

intubation is one of those.

I respect you, Kelton, and I am NOT bashing you. I'm just encouraging you to

seek truth rather than myth. Learn the anatomy and the mechanisms of injury

that occur. Read the literature. Get away from the Paramedic texts which are,

at best only the tip of the iceberg in medicine. If you only know what the

paramedic texts teach, you're a dumb paramedic.

When you do, you'll find that nobody who practices serious medicine believes the

ET tube cranial intubation myth. Don't be a Bozo.

Be smart. Seek truth.

Gene G.

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

>

May 7, 2010

You beat me to it Gene.

Once upon a time no sailor would sail past a point as we all knew the earth

was flat.

I have a suspicion that generations of post Columbus Sailors still would

not sail past that point as they never had and they didn't want to take the

chance the world was really flat.

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 5/7/2010 5:07:08 A.M. Central Daylight Time,

wegandy1938@... writes:

Why, Kelton?

Based upon what scientific evidence? I submit that this is an EMS myth

that has been promulgated by a lot of folks who ought to know better,

including the authors of the current texts.

Fine me ONE valid study that supports this myth.

GG

-----Original Message-----

From: Kelton <_keltongriffin@keltongri_

(mailto:keltongriffin@...) >

To: _texasems-l@yahoogrotexasem_ (mailto:texasems-l )

Sent: Thu, May 6, 2010 2:46 pm

Subject: Re: Re: Airway Question

You should never perform nasal intubation with any head injuries it is

contraidicated especially with suspected skull fractures.

________________________________

From: " _krin135@..._ (mailto:krin135@...) " _krin135@..._

(mailto:krin135@...) >

To: _texasems-l@yahoogrotexasem_ (mailto: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@_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) med_ (mailto:medic0946@_medic0946 (AT) yahoo (DOT) m

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]

May 7, 2010

You beat me to it Gene.

Once upon a time no sailor would sail past a point as we all knew the earth

was flat.

I have a suspicion that generations of post Columbus Sailors still would

not sail past that point as they never had and they didn't want to take the

chance the world was really flat.

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 5/7/2010 5:07:08 A.M. Central Daylight Time,

wegandy1938@... writes:

Why, Kelton?

Based upon what scientific evidence? I submit that this is an EMS myth

that has been promulgated by a lot of folks who ought to know better,

including the authors of the current texts.

Fine me ONE valid study that supports this myth.

GG

-----Original Message-----

From: Kelton <_keltongriffin@keltongri_

(mailto:keltongriffin@...) >

To: _texasems-l@yahoogrotexasem_ (mailto:texasems-l )

Sent: Thu, May 6, 2010 2:46 pm

Subject: Re: Re: Airway Question

You should never perform nasal intubation with any head injuries it is

contraidicated especially with suspected skull fractures.

________________________________

From: " _krin135@..._ (mailto:krin135@...) " _krin135@..._

(mailto:krin135@...) >

To: _texasems-l@yahoogrotexasem_ (mailto: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@_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) med_ (mailto:medic0946@_medic0946 (AT) yahoo (DOT) m

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]

May 7, 2010

You beat me to it Gene.

Once upon a time no sailor would sail past a point as we all knew the earth

was flat.

I have a suspicion that generations of post Columbus Sailors still would

not sail past that point as they never had and they didn't want to take the

chance the world was really flat.

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 5/7/2010 5:07:08 A.M. Central Daylight Time,

wegandy1938@... writes:

Why, Kelton?

Based upon what scientific evidence? I submit that this is an EMS myth

that has been promulgated by a lot of folks who ought to know better,

including the authors of the current texts.

Fine me ONE valid study that supports this myth.

GG

-----Original Message-----

From: Kelton <_keltongriffin@keltongri_

(mailto:keltongriffin@...) >

To: _texasems-l@yahoogrotexasem_ (mailto:texasems-l )

Sent: Thu, May 6, 2010 2:46 pm

Subject: Re: Re: Airway Question

You should never perform nasal intubation with any head injuries it is

contraidicated especially with suspected skull fractures.

________________________________

From: " _krin135@..._ (mailto:krin135@...) " _krin135@..._

(mailto:krin135@...) >

To: _texasems-l@yahoogrotexasem_ (mailto: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@_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) med_ (mailto:medic0946@_medic0946 (AT) yahoo (DOT) m

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]

May 7, 2010

How about the fact that even in light of the BS factor a non ventilated

Patient is pretty dead as well?

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 5/7/2010 7:45:46 A.M. Central Daylight Time,

delbert@... writes:

Listening to a neurosurgeon in Toronto - head of neurosurgery at huge level

I & med school - at a trauma conference a few years ago called the worry

about a tube being placed into the brain " BS " (but of course not

abbreviated) med school - at a trauma conference a few years ago called the

worry

about a tube being placed into the brain " BS " (but of course not abbreviat

Makes sense.

>>> " Jane Dinsmore " _texas.paramedic@..._

(mailto:texas.paramedic@...) > 5/6/2010 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@yahoogrotexasem_ (mailto:texasems-l )

From: _lnmolino@..._ (mailto: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/FF/N

Freelance Consultant/Trainer/Freelance CoFreelance Consultant/Trainer

_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 4:09:26 P.M. Central Daylight Time,

_krin135@..._ (mailto: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 (AT) aol (DOT) _ln_ (mailto:_lnmolino@...) _ (mailto:_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) __LNMolino (AT) aol (DOT)

_LNMolino@...) ) _ (mailto:__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@__medic0946@ ya__medic0946 (AT) yahoo (DOT) _me_

(mailto:_medic0946@...) ) _

(mailto:__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]

__________________________________________________________

The New Busy think 9 to 5 is a cute idea. Combine multiple calendars with

Hotmail.

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8326ocid=PID2832ocid=PID2ocid=PID28ocid=PID_

(http://www.windowslive.com/campaign/thenewbusy?tile=multicalendar&ocid=PID28326\

::T:WLMTAGL:ON:WL:en-US:WM_

HMP:042010_5)

[Non-text portions of this message have been removed]

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May 7, 2010

How about the fact that even in light of the BS factor a non ventilated

Patient is pretty dead as well?

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 5/7/2010 7:45:46 A.M. Central Daylight Time,

delbert@... writes:

Listening to a neurosurgeon in Toronto - head of neurosurgery at huge level

I & med school - at a trauma conference a few years ago called the worry

about a tube being placed into the brain " BS " (but of course not

abbreviated) med school - at a trauma conference a few years ago called the

worry

about a tube being placed into the brain " BS " (but of course not abbreviat

Makes sense.

>>> " Jane Dinsmore " _texas.paramedic@..._

(mailto:texas.paramedic@...) > 5/6/2010 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@yahoogrotexasem_ (mailto:texasems-l )

From: _lnmolino@..._ (mailto: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/FF/N

Freelance Consultant/Trainer/Freelance CoFreelance Consultant/Trainer

_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 4:09:26 P.M. Central Daylight Time,

_krin135@..._ (mailto: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 (AT) aol (DOT) _ln_ (mailto:_lnmolino@...) _ (mailto:_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) __LNMolino (AT) aol (DOT)

_LNMolino@...) ) _ (mailto:__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@__medic0946@ ya__medic0946 (AT) yahoo (DOT) _me_

(mailto:_medic0946@...) ) _

(mailto:__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]

__________________________________________________________

The New Busy think 9 to 5 is a cute idea. Combine multiple calendars with

Hotmail.

_http://www.windowslhttp://www.windohttp://www.whttp://www.windoht&ocid=PID2

8326ocid=PID2832ocid=PID2ocid=PID28ocid=PID_

(http://www.windowslive.com/campaign/thenewbusy?tile=multicalendar&ocid=PID28326\

::T:WLMTAGL:ON:WL:en-US:WM_

HMP:042010_5)

[Non-text portions of this message have been removed]

------------------------------------

Yahoo! Groups Links

===========================================================

This message is confidential, intended only

for the named recipient(s) and may contain

information that is privileged or exempt from

disclosure under applicable law. If you are

not the intended recipient(s)not the intended recip

that the dissemination, distribution or copying

of this message is strictly prohibited. If you

received this message in error, or are not the

named recipient(s)named recipient(s) , p

and delete this e-mail from your computer.

ETMC has implemented secure messaging for

certain types of messages. For more information

about our secure messaging system, go to:

_http://www.etmc.http://ww_ (http://www.etmc.org/mail/)

Thank you.

===========================================================

May 7, 2010

How about the fact that even in light of the BS factor a non ventilated

Patient is pretty dead as well?

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 5/7/2010 7:45:46 A.M. Central Daylight Time,

delbert@... writes:

Listening to a neurosurgeon in Toronto - head of neurosurgery at huge level

I & med school - at a trauma conference a few years ago called the worry

about a tube being placed into the brain " BS " (but of course not

abbreviated) med school - at a trauma conference a few years ago called the

worry

about a tube being placed into the brain " BS " (but of course not abbreviat

Makes sense.

>>> " Jane Dinsmore " _texas.paramedic@..._

(mailto:texas.paramedic@...) > 5/6/2010 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@yahoogrotexasem_ (mailto:texasems-l )

From: _lnmolino@..._ (mailto: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/FF/N

Freelance Consultant/Trainer/Freelance CoFreelance Consultant/Trainer

_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 4:09:26 P.M. Central Daylight Time,

_krin135@..._ (mailto: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 (AT) aol (DOT) _ln_ (mailto:_lnmolino@...) _ (mailto:_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) __LNMolino (AT) aol (DOT)

_LNMolino@...) ) _ (mailto:__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@__medic0946@ ya__medic0946 (AT) yahoo (DOT) _me_

(mailto:_medic0946@...) ) _

(mailto:__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]

__________________________________________________________

The New Busy think 9 to 5 is a cute idea. Combine multiple calendars with

Hotmail.

_http://www.windowslhttp://www.windohttp://www.whttp://www.windoht&ocid=PID2

8326ocid=PID2832ocid=PID2ocid=PID28ocid=PID_

(http://www.windowslive.com/campaign/thenewbusy?tile=multicalendar&ocid=PID28326\

::T:WLMTAGL:ON:WL:en-US:WM_

HMP:042010_5)

[Non-text portions of this message have been removed]

------------------------------------

Yahoo! Groups Links

===========================================================

This message is confidential, intended only

for the named recipient(s) and may contain

information that is privileged or exempt from

disclosure under applicable law. If you are

not the intended recipient(s)not the intended recip

that the dissemination, distribution or copying

of this message is strictly prohibited. If you

received this message in error, or are not the

named recipient(s)named recipient(s) , p

and delete this e-mail from your computer.

ETMC has implemented secure messaging for

certain types of messages. For more information

about our secure messaging system, go to:

_http://www.etmc.http://ww_ (http://www.etmc.org/mail/)

Thank you.

===========================================================

May 7, 2010

BINGO, Chuck.

Not to isolate the person you're replying to, most paramedics would fail your

test, because most have never heard of a LeFort fracture nor have a clue about

what it is.

Further, most paramedics can't give a medical reference for anything that's not

in the ONE text they studied in class. They're blissfully unaware that there

are vast medical resources outside their ONE text. Many don't know what you

mean when you say, " medical reference. "

Sad.

GG

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@_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) med_ (mailto:medic0946@_medic0946 (AT) yahoo (DOT) m

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]

May 7, 2010

BINGO, Chuck.

Not to isolate the person you're replying to, most paramedics would fail your

test, because most have never heard of a LeFort fracture nor have a clue about

what it is.

Further, most paramedics can't give a medical reference for anything that's not

in the ONE text they studied in class. They're blissfully unaware that there

are vast medical resources outside their ONE text. Many don't know what you

mean when you say, " medical reference. "

Sad.

GG

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@_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) med_ (mailto:medic0946@_medic0946 (AT) yahoo (DOT) m

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]

May 7, 2010

BINGO, Chuck.

Not to isolate the person you're replying to, most paramedics would fail your

test, because most have never heard of a LeFort fracture nor have a clue about

what it is.

Further, most paramedics can't give a medical reference for anything that's not

in the ONE text they studied in class. They're blissfully unaware that there

are vast medical resources outside their ONE text. Many don't know what you

mean when you say, " medical reference. "

Sad.

GG

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@_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) med_ (mailto:medic0946@_medic0946 (AT) yahoo (DOT) m

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]

May 7, 2010

Hi Gene,

I just had to comment on a few of your statements re: Arizona and the EMS

education practices.

First, I agree that Az is behind most of the nation re: change.

Unfortunately, much of the resistance comes from the Bureau-crapsy at the

state level. Dr. Ben Bobrow, the state medical director, is trying his best

to change that - but it does take time.

I also agree that two large fire departments - Tucson and Phoenix - have a

powerful hold on how EMS operates statewide. Many of us have argued this

for years. And, we have done all we can to convince the powers to be that

this is the case.

I disagree with your statement, however, that there are no paramedic leaders

within Arizona. Dr. Ron Salik certainly is a paramedic leader. Pete Bidon

is a paramedic leader. Mark Venuti is a paramedic leader. You're a

paramedic and I certainly consider you a leader - that's why I asked you to

be part of our program when I was the Assistant Director of Allied Health at

Cochise College.

So, here's your challenge, Gene - if you agree to accept it J: Create,

nurture, and expand the future leaders of Arizona's EMS community. Create a

list-serv on this topic. Attend the meetings regularly in Phoenix (which

you have in the past).

A few of us fought for years to affect change. Some of us have left. But ALL

of us collectively can help bring Arizona out of the dark ages. We just have

to remember that it is our light that will remove the darkness and help

others see what needs to change.

Respectfully,

Mike Grill, MS; NREMT-P and Arizona Certified Paramedic

EMS Educator

Porter, Littleton and EMS Adventist Hospital EMS Team

Littleton, CO.

Email edited removal of previous emails on topic. Thanks Moderator

May 7, 2010

Hi Gene,

I just had to comment on a few of your statements re: Arizona and the EMS

education practices.

First, I agree that Az is behind most of the nation re: change.

Unfortunately, much of the resistance comes from the Bureau-crapsy at the

state level. Dr. Ben Bobrow, the state medical director, is trying his best

to change that - but it does take time.

I also agree that two large fire departments - Tucson and Phoenix - have a

powerful hold on how EMS operates statewide. Many of us have argued this

for years. And, we have done all we can to convince the powers to be that

this is the case.

I disagree with your statement, however, that there are no paramedic leaders

within Arizona. Dr. Ron Salik certainly is a paramedic leader. Pete Bidon

is a paramedic leader. Mark Venuti is a paramedic leader. You're a

paramedic and I certainly consider you a leader - that's why I asked you to

be part of our program when I was the Assistant Director of Allied Health at

Cochise College.

So, here's your challenge, Gene - if you agree to accept it J: Create,

nurture, and expand the future leaders of Arizona's EMS community. Create a

list-serv on this topic. Attend the meetings regularly in Phoenix (which

you have in the past).

A few of us fought for years to affect change. Some of us have left. But ALL

of us collectively can help bring Arizona out of the dark ages. We just have

to remember that it is our light that will remove the darkness and help

others see what needs to change.

Respectfully,

Mike Grill, MS; NREMT-P and Arizona Certified Paramedic

EMS Educator

Porter, Littleton and EMS Adventist Hospital EMS Team

Littleton, CO.

Email edited removal of previous emails on topic. Thanks Moderator

May 7, 2010

Hi Gene,

I just had to comment on a few of your statements re: Arizona and the EMS

education practices.

First, I agree that Az is behind most of the nation re: change.

Unfortunately, much of the resistance comes from the Bureau-crapsy at the

state level. Dr. Ben Bobrow, the state medical director, is trying his best

to change that - but it does take time.

I also agree that two large fire departments - Tucson and Phoenix - have a

powerful hold on how EMS operates statewide. Many of us have argued this

for years. And, we have done all we can to convince the powers to be that

this is the case.

I disagree with your statement, however, that there are no paramedic leaders

within Arizona. Dr. Ron Salik certainly is a paramedic leader. Pete Bidon

is a paramedic leader. Mark Venuti is a paramedic leader. You're a

paramedic and I certainly consider you a leader - that's why I asked you to

be part of our program when I was the Assistant Director of Allied Health at

Cochise College.

So, here's your challenge, Gene - if you agree to accept it J: Create,

nurture, and expand the future leaders of Arizona's EMS community. Create a

list-serv on this topic. Attend the meetings regularly in Phoenix (which

you have in the past).

A few of us fought for years to affect change. Some of us have left. But ALL

of us collectively can help bring Arizona out of the dark ages. We just have

to remember that it is our light that will remove the darkness and help

others see what needs to change.

Respectfully,

Mike Grill, MS; NREMT-P and Arizona Certified Paramedic

EMS Educator

Porter, Littleton and EMS Adventist Hospital EMS Team

Littleton, CO.

Email edited removal of previous emails on topic. Thanks Moderator

May 7, 2010

Listening to a neurosurgeon in Toronto - head of neurosurgery at huge level I &

med school - at a trauma conference a few years ago called the worry about a

tube being placed into the brain " BS " (but of course not abbreviated). The point

being that if the patient has a hole in their cribiform plate so large that an

ETT would pass through it.....they were dead anyway.

Makes sense.

>>> " Jane Dinsmore " texas.paramedic@...> 5/6/2010 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

>

May 7, 2010

Listening to a neurosurgeon in Toronto - head of neurosurgery at huge level I &

med school - at a trauma conference a few years ago called the worry about a

tube being placed into the brain " BS " (but of course not abbreviated). The point

being that if the patient has a hole in their cribiform plate so large that an

ETT would pass through it.....they were dead anyway.

Makes sense.

>>> " Jane Dinsmore " texas.paramedic@...> 5/6/2010 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

>

May 7, 2010

Listening to a neurosurgeon in Toronto - head of neurosurgery at huge level I &

med school - at a trauma conference a few years ago called the worry about a

tube being placed into the brain " BS " (but of course not abbreviated). The point

being that if the patient has a hole in their cribiform plate so large that an

ETT would pass through it.....they were dead anyway.

Makes sense.

>>> " Jane Dinsmore " texas.paramedic@...> 5/6/2010 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

>

May 7, 2010

So, Wikipedia isn't a reference?

-Wes

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@_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) med_ (mailto:medic0946@_medic0946 (AT) yahoo (DOT) m

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

>

May 7, 2010

So, Wikipedia isn't a reference?

-Wes

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@_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) med_ (mailto:medic0946@_medic0946 (AT) yahoo (DOT) m

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

>

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