lesson in common sense #36...

we are going through some changes over the last year and a half in our system. our new boss, appearing at first to be a big talker, has has come through with some very needed changes. but occasionally there are a few knee-jerk reactions to ANY type of "bad press", no matter how poorly sourced and one-sided the editor of the Cheers and Jeers section happens to be. the inability to attack weak local journalism is a shame for such a politically oriented boss.
today i wish to examine a lack of common sense by the Yes-Men he has surrounded himself with. according to our new state protocols we need a blind insertion device (BIAD) for adults AND pediatric pts. a quick explanation of the use of a BIAD:

in case we are unable to perform an intubation via laryngoscope, after 2 attempts we have the choice to throw in a Combitube and go from there. easy to do and has worked perfectly everytime i have used one. it is so easy to use i can show some 18 year old country hick first responder just once, and he can do it right everytime. the majority of times i have seen failed airways is on TALL, heavy black guys who naturally have large tongues (see: Mallampati airway classification)and no necks.

as for a pediatric BIAD, no big deal there. King Airways makes a wonderful product (see above photo) easy enough, just purchase a size #3 and done. keep our tried and true Combitube and add the King #3. but Sadly, No. our system (and now all the city fire stations) go and throw out the Combitube and buy King #3 and #4. the #3 is for persons 4-5 feet tall and the #4 (our NEW adult BIAD) is for persons 5-6 feet tall. notice anything? of, course you did as did every fire fighter i have talked to....what about a person over 6 feet tall?!?! as medics this is sorta a moot point, we now have numerous other choices in case of a failed or difficult airway (Bougie, AirTrack, surgical, etc.) but the first responders now have to bag (using an OPA/NPA, of course) and try and keep a person oxygenated while they wait for us to get to the scene to intubate. a lack of common sense can result in death in a busy system like we run. and it is funny how the people who make a lot of the major decisions in our system are the people farthest from running on an actual truck. not that i think the regular paramedics have the time to sit in all these meetings, but at least try and get their opinion occasionally about product use and need. oh, and to just show how easy it is to place a Combitube in an adult i'll let this crazy German doctor show you....