I think the experience of the paramedic is crucial to framing an
appropriate answer to this question. We have some paramedics
(particularly our State Trooper flight paramedics, and some Baltimore
City paramedics) who are quite familiar with pediatric airways and could
profitably look and determine whether the tube is correctly positioned.
There are others who would have great difficulty determining placement by
I think the emphasis needs to be on observation of chest rise, listening
for breath sounds, and overall assessment of ventilation, with a direct
look recommended only for those who are experienced and knowledgeable. I
realize that that is hard to put into a textbook, and almost impossible
to document, but there needs to be some room for individual judgment.
Have a great 4th.
Allen R. Walker, MD
Pediatric Emergency Medicine
On Fri, 30 Jun 1995, Jim Greenberg wrote:
> The following comes from a group writing a textbook for paramedics. Your
> comments would be appreciated:
> The laryngoscope may be reinserted to visualize the tube and glottic opening
> as an option to confirm questionable tube placement. However, some
> specialists state that this procedure is too dangerous to perform on
> pediatric patients and should not be recommended, especially to those who
> only occasionally manage the pediatric airway.
> Have you used this? Frequency? Useful or not? (We recognize that
> auscultation, observation of chest rise, and CO2 detection are best.)
> James A. Greenberg, M.D. <[log in to unmask]>
> Department of Anesthesiology - 7469 DeSoto Wing
> Children's Hospital of Pittsburgh - 3705 Fifth Avenue
> Pittsburgh, PA 15213
> Voice: (412) 692-5260 Fax: (412) 692-8658