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This is an intriguing, yet somewhat frightening idea when applied
to the pediatric patient, who individual out of hospital providers treat
quite infrequently (according to the literature). We have recently found
that when out of hospital providers provide only oxygen during prehospital
care to ED patients who are intubated in the ED, that patient mortality
is higher after adjusting for intubating personnel, age, and clinical
condition of the patient (Ann Emerg Med 1994;23;628).  This suggested to
us that some form of medication assisted endotracheal intubation may be
beneficial in this subgroup of patients.
 
So I feel that the answer is not clear.  I would encourage individuals in
systems where prehospital muscle paralytics are used in children to report
their findings to provide more information.
 
In the meantime, my view is teach as many out of hospital providers (at
all levels of training) to perform safe and effective mouth to mask or bag
mask ventilation.  To me, teaching a few advanced level providers to
perform a rare skill is less effective than teaching a larger number of
providers effective ventilation skills.
 
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Thomas E. Terndrup, M.D., F.A.C.E.P.
Department of Emergency Medicine
S.U.N.Y. Health Science Center at Syracuse
750 E. Adams St.
Syracuse, N.Y.  13210
/Fax# (315) 464-6229     /E-mail [log in to unmask]
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