“…obnoxious sound-bytes like, ‘the only prehospital fluid of use is gasoline’, outdated dogma like that needs to be put in a box with the rest of 1980’s ATLS crap…”

Amen! [reader note, US providers prefer diesel boluses]

Here’s an update since that was recorded. (1) Equipment: we know carry iGel instead of LMA. We are likely to acquire the King Vision as our video laryngoscope, to be carried on interhospital missions (not for pre-hospital trauma). (2) Since recording the podcast, we have had two failed intubations pre-hospital, both in obese trauma patients. Each case was rescued effectively in the field by laryngeal mask airway without desaturation. One case was successfully intubated in hospital by an anesthetist using video laryngoscopy; the other had failed intubation attempts by anaesthesia staff in the receiving ED and ended up requiring a… Read more »

Hi guys what a coincidence! I was taking some photos of us testing the King Vision video laryngoscope only yesterday for that review you wanted Scott! The article will be on the way to you soon! I have to agree with Cliff about having the device in the prehospital setting. Its the only VL we have tested that gives a decent image in direct sunlight and does not cost an arm and leg to purchase. I saw the French study proposal looking at GLidescope vs DL..it follows on from case reports and retrospective studies out of GErman HEMS experience with… Read more »

Great pt 2 of the interview. Fantastic stuff on prehospital amputation.

about prehospital needle cric, my RFDS colleagues in Western Australia have done two successful ones and in QLD a Careflight doctor did a Melker seldinger cric last year on a guy with Ludwigs

Hi Cliff, on your interview Scott challenged you on the notion of protocol based management and I have to agree with him. Protocols are a necessary evil as they establish ground rules for safe and quality practice. Sure they should be improved and promote current best practice. The concept of doing whats best for the patient at the right time by the right person etcetcetc, is a very elusive one. Experience and keeping up to date does count but thats only half the story.The airway cases I cited are testimonies to that.And Scott’s right, you can’t have experienced doctors everywhere.… Read more »

When looking at supraglottic airways in Rich Levitan’s cadaver lab the four physicians from our service all agreed on the following: Cookgas was our favourite iGel was beautiful in its simplicity and great for our paramedics as well as our doctors Both were easy to intubate through using a ‘fibreoptic’ guided technique (using the Ambu A-scope, which technically is not a fibreoptic device but behaves like one). Of the VLs, King Vision won hands down. Unfortunately, we were unable to find a supplier of Cookgas in Australia, which is why we went for the iGel. We therefore now have: Prehospital:… Read more »

Cliff, what an airway kit you guys now carry! I understand the iGel decision now that you also got the Ambu Scope. Having said that your stats show only two failed intubations in how many years? I would have just gotten the King Vision VL and left it at that but hey its only tax payers money…hahahaha
Be like water, friend.

My colleague Dr Karel Habig made this video of our training for new retrieval physicians in July.

http://www.youtube.com/watch?v=VWuX8pV7Ceg&w=560&h=315

Cliff

Minh

Can I get you to clarify your comment on the iGel/Ambusope connection? Do they play together well, in your view?

Our ED uses iGels as the supra-glottic rescue device of choice (the inventor of the iGel is one of our anaesthetic doctors).

I’m currently discussing with our anaesthetists the issue of adding an Ambuscope to our difficult airway trolley and wanted any views on the role of the Ambuscope in the ED when it comes to the difficult airway.

Thanks

Dean