Rekindle your enthusiasm for EMS: Your burnout repair guide
Innovative and high-quality respiratory and airway products
Today: EMS, we have encountered a major problem. Join us and learn about strategies to meet the challenges of EMS
With a range of techniques and tools for upper respiratory tract suction in a pre-hospital environment, it is important to evaluate the patient and choose the correct method
Sponsored by Bound Tree Medical
Author: Tim Nowak for EMS1 BrandFocus
The grunting sound... A sound that an EMS provider may hear when approaching a patient, causing them to immediately enter the airway management mode.
What caused the airway obstruction in this patient? Is it a trauma? Poisoned? How about some kind of reaction?
You were sent to participate in a motorcycle accident, and a patient was ejected from the motorcycle after hitting the back of another car. You find that your patient without a helmet is lying prone on the sidewalk with blood stains around. When you maintain spinal movement restriction and roll your patient into a supine position, there will be an audible grunt due to blood in the upper airway.
You are unlikely to carry a battery-powered suction device with you to evaluate your patient, so what other options are available in your trauma bag or primary reaction bag to handle the suction blood in the patient’s airway?
How about a simple hand pump suction device? Several pumps on the device may be sufficient to quickly remove blood or other secretions from the patient’s airway. These tools are a compact, one-time, and inexpensive option that can be stored in multiple locations in your device cache.
Blood that obstructs the airway can have many obvious negative effects, including clotting, promoting vomiting when swallowing, and simply obstructing airflow due to accumulation in the oropharynx.
When you transport your semi-reactive (to loud speech stimulation) patient suspected of alcoholism to the emergency room, he will move from a comfortable side position to a supine position on your cot. After completing the telephone report to the receiving hospital, you heard that the patient started to vomit... and then you noticed that he was vomiting.
You hang up the phone and briskly let the patient sit upright. Wiping off his first round of vomiting, the patient entered the second round and continued to vomit, feeling like eternity. Repositioning him to the position of Gao Fowler helps, but it does not solve the new airway problem you are facing, namely how to prevent inhalation and obstruction to patients who have changed but are not unconscious.
Try to turn your patient back to his side (recovery position), you consider your airway suction options. Assuming he has a complete vomiting reflex, inserting any type of tube into his mouth will not cause a positive reaction. Therefore, gravity seems to be your best choice at the moment.
In order to avoid exposing a large amount of body fluids in the ambulance, you frantically reach out for a vomit bag that can be easily hung behind you. Fortunately, you can avoid the floor and the crib as well as the serious mess that you have caused yourself.
You respond to a patient experiencing an excitatory delirium event and find that he is agitated, hallucinating, growling, and hyperthermia. After giving the patient an appropriate dose of ketamine via intramuscular route, you fix him in your crib and start transporting him to the hospital with additional riders to provide physical support.
Within a few minutes after starting the transfer, your patient is still separated and begins to show signs of excessive salivation. Although most of the saliva can be wiped from the outside of his mouth, you will notice that there is still too much saliva in his mouth. Before trying to reposition your patient into a lateral position, he begins to gag.
Fortunately, repositioning him allows you to clear his airway to make it patent. When you reflect on the events of this call, you will think about your oral suction process. You note down the location of the wall-mounted suction device and the portable device. You will think about the intubation and the challenges you encountered in the last secretion-filled airway, and how necessary aspiration is to clear the way for advanced airway placement.
Do you remember the location of the flexible suction catheters for each of your tracheal intubation and supraglottic airway devices, as well as the location of the hard suction catheters. You might even think of one time when you used a meconium aspirator to remove excess pulmonary edema secretions from the airways of a previous CHF patient. She is beyond the scope of airway management through CPAP, so advanced airway is the next incremental step.
Fortunately, this call does not require any of these interventions, but due to your previous experience and familiarity with the equipment, you will definitely be ready for it now.
Each of these case scenarios provides its own lessons. Some are as simple as patient positioning, while others require more active and invasive suction procedures. Knowing the location of your equipment and the location of its backup equipment is a key factor in the rapid deployment of suction technology.
Preparing for damage to the airway, especially when suction is required, is a key part of airway management for BLS and ALS. The experience you gained from the initial training, combined with your own on-site experience and the shared experience of some of your instructors, increases your confidence in on-site airway management.
Having the right tools for the job plays a key role in this regard. After all, suction without the right tools is like an injury without a splint. You may be able to use MacGyver as you want, but it is usually not a substitute for the right tools and knowledge in your arsenal.
Tim Nowak, AAS, BS, NRP, CCEMT-P, SEMSO, is the founder and CEO of Emergency Medical Solutions, LLC, an independent EMS training and consulting company he developed in 2010. Since 2002, he has been involved in EMS and emergency services, and has worked as an EMT, paramedic, and intensive care paramedic in various urban, suburban, rural, and hospital settings. Throughout his career, he has also served as an EMS educator, consultant, project writer, clinical instructor, board member, reference product developer, firefighter, and HazMat technician.
Request information from Bound Tree Medical
By submitting your information, you agree to be contacted by the selected supplier, and the data you submit is not subject to the "Do Not Sell My Personal Information" request. Check our terms of service and privacy policy.
More binding tree medical products
Inventory management technology can help your organization keep track of items that need to be restocked without the need for time-consuming manual inventory
It is important for EMS suppliers to understand how to properly use the available bleeding control tools
Gone are the days of just visualizing the tube passing through the rope and observing whether the tube is foggy with the help of technology that helps to verify the position of the tube
Copyright © 2021 EMS1. all rights reserved.
Copyright © 2021 Lexipol. all rights reserved. Do not sell my personal information
EMS1 is revolutionizing the way the EMS community finds relevant news, identifies important training information, interacts with each other, and researches product sourcing and suppliers. It has become the most comprehensive and trusted online destination for pre-hospital and emergency medical services.
Copyright © 2021 Lexipol. all rights reserved. Do not sell my personal information
Visit other EMS1 network sites:
If you need more help setting up your homepage, please check the "Help" menu of your browser