I think the discussion on this issue is fundamentally misdirected.
Yes, you could save someone using a cric. You could also save
someone performing an open thoracotomy, pericardiocentesis, or cross
clamping an abdominal aorta. You could also harm a lot of people as
well. Most the docs on this list would strongly discourage crics in
children because it is technically too problematic. Studies from the
EM literature have shown a significant complication rate in the hands
of physicians who regularly practice this procedure.
You just can't do every possible thing there is to do. For every
person you help, many may be harmed. Who can predict that more will
be saved than killed by this procedure in unpracticed hands
(unpracticed because it's so rarely needed)? At some point, you have to say
that enough is enough. Arguing to do a possibly dangerous procedure that you may do
once in your life is not a great idea.
end tidal CO2 and pulse ox's, of course, are as follows:
1. end tidal CO2 - motherhood
2. pulse ox - apple pie
> I have some reservations relying heavily on BLS airway management of the
> peds patient in arrest or near arrest. We as paramedics go through
> extensive training which empahsizes assessment over and over and over -
> especially with the peds patient. Because of this, hopefully an errant
> espohageal intubation can be detected and corrected. One of the biggest
> problems in managing a cardiac arrest - or any patient that a BLS
> procedure is being used to ventilate the patient is gastric distention.
> Prehospitally - we don't have NG tubes and consequently end up with high
> risk for aspiration and airway occlustion b/c of emesis. No matter how
> careful one ventilates with a BVM - the patient will eventually vomit.
> Intubation is the way to go - it's a sure-thing - provided it is
> constantly maintained. This brings up another problem - in infants and
> newborns the tube can become dislodged very easily. - Once again -
> constant assesment - including ETCO2 and SaO2 can aid in detecting this
> problem immediatly.
> Actually what brought up the peds cric question: a group of us
> "squirrells" were discussing anaphalaxis and eppiglotitis in rural
> settings - and the long response times involved for EMS. The question
> came up about kids and what to do. Our Medical Director, Dr. Ed Racht
> told us that he wouldn't have a problem with our using the cric - but we
> had better have exhausted every possible means of ventillating the
> patient. Goal #1 is airway. I just hope and pray that I never have to
> do it - or that if I am ever in that situation - my partner drives really
> fast so that those of you, whose ranks I aspire to join (M.D.'s) can
> manage the patient.
> Tom Hesbach, NREMTP
> Forest View Volunteer Rescue Squad
> Richmond, VA
Peter Viccellio, MD, FACEP
Vice Chairman, Department of Emergency Medicine
University Hospital, L4-515
SUNY at Stony Brook School of Medicine
Stony Brook, NY 11794
"Maturity is a bitter disappointment for which there
is no remedy, unless laughter can be said to remedy
---- Kurt Vonnegut ----