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From: emtskills
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  • I'm an EMT-B, Paramedic student in Ohio. Intubation is still currently in the basics scope for the state, but is being taken out after the first of the year. Just wanted to add my two cents! :)

  • I Live in Wichita, KS and I am currently taking an EMT course. As EMTs we are absolutely allowed to perform Endotracheal intubations. I'm actually learning this right now.

  • Endotracheal Intubation is no longer allowed for EMT-Bs in any state that I know of. I think some states allow blind insertion devices like the King tube.

    New York allows its Intermediates to do ET.

  • i thought only als could do this?

  • this video is outdated. :p

  • they are doing that so wrong... you dont rock back, you pull foward because otherwise you could break teeth....not mention we don't hyperventilate anymore, you just pre-oxygenate... where i am in virginia that is an intermediate skill

  • circumferential taping is incorrect

  • california don't allow emt-b to intubate do they?

  • @jazelle24 don't think so, neither does IL

  • it says something about pre hypervented

  • pre-oxygenate.

  • they should have preoxygenated with 100% oxygen before they inserted the ET. Plus they should specify wether using a Combitube, MultiLumen or LMA. Not the best video, but not horrible.

  • Why would they say they were using a Combi, Multi or LMA if they are clearly Intubating with an ETT, and none of the devices you mentioned.

    You tend to not use a Laryngescope with a blind-insertion device.

  • lol sloppy job

  • Intubation by Basics was allowed here in South Carolina until January of this year.

  • Methinks he's going to have a very expensive dental bill coming his way.

  • I agree, Levering on the teeth is not the correct way and offers no mechanical advantage.The anaesthetists (or anesthsiologists in other countries) I work with would not be impressed if I used that technique on our patients!

  • Sorry, I get a haircut every two weeks so I don't qualify for being a guitar junkie.

    It isn't useless to have the EMT-I because it allows services to run BLS with only two EMT's in lower call areas and counties that can't afford to go all out ALS. We have parts of our county covered where it is BLS only because theres only several calls a day and ALS is nearby if needed badly enough, or even Life Star.

  • I agree with you on that one. In my county most of the ambulance companies staff their regular ambulances with two EMT1 or an EMT1 and EMT2 in our county all the Fire Departments staff Paramedics which respond to all EMS calls with the EMTs. One of the local Ambulance companies has a hand full of CCT ambulances which have a paramedic onboard. If all else fails there is always Mercy Air.

  • Agreed. Pennsylvania just signed into legislature the EMT-A, which is basically an EMT-I. My EMT instructor, who is a medic, told me its completely necessary to have EMT-A's

  • I don't know what parts of Ohio these people, who are saying EMT-B's can intubate, live in but you can't do it in this city.

    The Medical Directors here contraindicate intubation unless it's going to be done by an EMT-I or EMT-P.

  • In general this is not a basic skill with the exception of a few states (primarily ohio). Even still it is usually only on pulseles and apneic patients. In any event, there are several quality back up airway devices such as LMA, King LT, combitube which are just as effective for someone who does not intubate on a frequent basis. To be efficient at this skill, it must be done on a frequent basis and one every couple months isn't enough. Crunch time is not the time to stress about proficiency.

  • jessemedic, sorry to say you are incorrect. Basics can intubate in some states, thats why you are tested on your registry. In the state of ohio, basics can intubate, according to protocols but state says pulseless and apenic.

  • This is a really good video. Also consider 1. Having suction at intubation. It is only mentioned at ETT removal in this video. Hyperventilation in someone with a full stomach could lead to regurgitation and aspiration so be prepared

  • hey great tube you twit!! now you have an obstructed airway as the Pt has no teeth left!! Paramedic or not, if your going to tube...do it right

  • Paul, Check your facts. Some states allow EMT-I's to intubate. Not just paramedics.

  • Isn't an EMT-I not an EMT-Basic. So, the original comment about it not being a basic skill would still stand, no?

  • Idaho does since we no longer use EOAs . Some areas are using Combitubes .

  • u ve made it complicated

  • In Ohio we can preform an intubation on dead people :D

  • subroc- i kno for a fact that in my state, it is a skill, BUT!!, my medical director does NOT allow for basics to intubate. We do learn it in class, we do it for our practical exam.

  • Not an EMT-Basic skill. Only a Paramedic skill.

  • we dont have that laryngoscope thing in my class. We use a adjunct to hold the tongue out of the way.

  • So this is EMT only and first responders can't do this?

  • correct.

  • EMT's can not intubate. First responders certainly can not intubate. In many states, the EMT-Intermediate can intubate. And in all state, Paramedics can intubate. EMT's are taught blind insertion airways, like combitubes, EOA's, and King LT devise. Not endotracheal intubation.

  • DL and ET tube skills are listed under the NREMT-B Skills. Your state or local protocols may not allow you to practice these skills, but they ARE BASIC NREMT SKILLS! Most EMT-B text Books even dedicate a chapter or appendix to advanced airway management, but still students say, "Intubation is not in my scope of practice". You are welcome to argue with the NREMT about this.

    P.S. Dr.S /buttcole, If I said the air is a solid...I am sure someone will take me seriously and start youtube fights..lol

  • Endotracheal intubation is a paramedic skill only (in EMS). National Registry EMT textbooks talk about it for two reasons. One, so the EMT working on an ALS ambulance will be able to effectively assist the paramedic, and two, because in most states, intermediates can also intubate. So the EMT text book would be used as an introduction. But Basics can not intubate in any state legally.

  • 1 BBF and CPP are related; when P fals so does F. Have U studied phisics?

    2 Hypvent doesn't increase ICP. as U said

    3 Me gustaría ver que escribas en español sin un solo error

  • and sorry again for my english, that isn't as good as yours... ¿are U bi-lingual buttcole?

  • does it matter if i speak another language frequently or not? no it doesnt. what im saying is ventilation a patient in a matter that is faster then the normal limit for lets say an adult which is 12-20 breaths per minute can be harmful to a patient especially TBI patients. now how can you deny that? i will try and find the article that was in a iemsa news letter i got that is titled "death by hyperventilation" and then maybe you can see my point. HYPERVENTILATION CAN KILL!

  • hyperventilating a patient with TBI can kill due to it´s effect on brain blood flow (BBF), thats for sure; in other hand, hyperventilation does not increase ICP as you said erlyer.

    Now, we are not talking about hyperventilating for long periods, only prior to ETI (30 to 45 sec): if U hyperventilate for les than one minute you won´t put down BBF enough, and if U R carefull with the presure used, U won´t cause a pneumothorax either. Hyperventilation is a safe way to hyperoxigenate before RSETI

  • RSETI = Rapid Sequence Endo Traqueal Intubation

    And i know it doesn´t matter if you are not bilingual... but also know that you shouldn´t say "i find it hard to believe that you study medicine, you cant even spell hyperventilation or frequence right". Just because i have trouble with some words in your languaje it doesn´t mean that i didn´t study medicine and a madical speciality.

    Greetings.

  • i still do find it hard to believe you can go through school especially med school and mispell every other word.

  • Bueno ¿qué te parece si escribimos los dos en español? A ver cuantos errores cometes tú... ;)

    (Well, how about if both write in spanish? Let's see how many mistakes you have... ;)

  • Misspell... Misspell... I'm Mexican, I can have mistakes when using english... but U? Writing wrong when U R trying to criticize my writing?

  • i dont care what you say, hyperventilation is bad in patients plain and simple you can try and persuade me but its not going to work, i know hyperventilation can affect CPP or cerebral perfusion pressure, and how generic does BBF sound, it sounds like you made that up, i agree with HYPEROXYGENATION patiens but not hyperventilating before RSI

  • 1.- BBF and CPP are related; when CPP fals so does BBF (BBF, aka CBF, Cerebral Blood Flow). Haven't U studied phisics? It's hard to understand that an EMT doesn't know this. ¿are U sure U passed all UR exams?

    2.- Hypvent doesn't increase ICP. as U said in UR first messages... Every body knows this.

    3.- If U want to discuss medicine, please, go to College first.

  • And I didn´t "made it up". BBF (or CBF; Cerebral Blood Flow) was described ages ago. Maybe is´s useless to discuss medicine with U.

  • this is not a good video to learn on, 1st you dont hyperventilate any pt,this can cause many unwanted side effects such as a pneumothorax, increased intracranial pressure, 2nd i would never intubate with a stylet that isnt the right size or sticking out, 3rd intubation can be performed on patients that arent in cardiac arrest, if your a good paramedic you would know this, 4th the guy is squeezing the bag way too much normal tidal vol. is only 500 ml, standard rule is to maintain chest rise

  • most states including the national registry and iowa intubation using and ETT is not a basic skill

  • Buttcole... every book or article on traqueal intubation insist on previous hiperventilation; hiperventilation does not cause pneumothorax, nor increases I.C.P.

    Greetings.

  • when did you go to school? hyperventilation is OLD, yes it can cause pneumothorax, and just out of curiosity what level are you, i am currently in a paramedic specialist class and we had a trachea and lungs from a pig and caused a pneumothorax just by hyperventilating. you should read current studies on ventilating patients before you try and make a point, and for the record you should "hyperoxygenate" a patient before intubation.

  • to satisfy your curiosity, I studied Medicine and the speciality in anaesthesiology and resucitation and i'm an ACLS AHA instructor; and to continue whith this... I supose you know all about rapid sequence intubation, used in most trauma and medical emergencies ¿how do U expect to "hiperoxigenate" in a short time without hiperventilation?

    Just remember that term "Hiperventilation" refers to the VENTILATION RATIO or FRECUENCE, not to the Tidal Volume used to ventilate...

  • i find it hard to believe that you study medicine, you cant even spell hyperventilation or frequence right, and yes tital volume has everything to do with ventilation, you hyperoxygenate a patient with 100% high flow oxygen at a rate that is still within normal limits just high normal. so heres what you people who think they know, a. get spell check before you try and act like a doctor. b. read current and accurate studies. c. actually practice in this field and get experience taking care of pts

  • Buttcole, english is my second language and so i have obvious mistakes for that. Seccond, let me quote something form a ASA article on ETI

    "The literature suggests that either traditional preoxygenation (3 or more minutes of tidal volume ventilation)or fast-track preoxygenation (i.e., four maximal breaths

    in 30 s) is effective in delaying arterial desaturation during subsequent apnea"

    and we should understand that fast-track preoxigenation (4 maximal breaths in 30 sec) as hiperventilation

  • i don't think thats a real person ...

  • The explanation is quite complete, but the execution of the technique in not so good:

    The stylet isn´t folded as comented.

    The Laryngoscope has a handle and it should be taken by it (without touching the blade; this gives other mistake... when pulling the handle the movement is not completely upwards; the EMT pulls towards his face makeing presure over the lip and the superior teeth).

  • Now where is this a basic skill? In GA they won`t even let Intermediates play ET Intubation. We gotta use Combi-tubes, LMAs and King airways.

  • at lease GA will let basics preform this skill. MD wont let Basics preform any type of intubation. All we can do for an airway is nasal and oral airways. Everything else for an airway is a medic skill.

  • im 20yrs old and i still dont have a clue what career to take, ive been considering respiratory therapy, but still dont know yet..im considering being an EMT to explore what its like in the med field...does anyone know how long classes are for and how fast i would be able to start and make money??, i live in los angeles california

  • I completed the EMT Basic here in South Carolina, and we are allowed to do this..And it is on the Registry test

  • just curious but im pretty sure i know your not talking about the national registry

  • I'm in the process of completing my EMT-B cert in Virginia and this is NOT an EMT-B skill in VA...waaay out of the scope of practice. Nasal trumpets and Oral airways are the only airway an EMT-B may perform here

  • Im a Nurse. I wanted to become a firefighter. EMT is the first step.

  • Um, ET intubation IS an EMT-B Skill although there is talk of them taking off the exam.

  • There's no way this is an EMT-B skill. What some people maybe referring to is the new "Combi-tube" or the "LMA", which is a somewhat advanced airway technique currently being used or tested in several states at the EMT-B level. There is no laryngoscope, and the Combitube is a "blind insertion". It has two inflation tubes, so if you miss and inflate the wrong one, you can simply deflate it and inflate the other cuff and you're good to go.

  • I live in Missouri and im in an EMT class and thats one of our basic skills on our registry test.

  • Is it an EMT-Intermediate or EMT-Airway course? I can understand that, but EMT-Basic? News to me. Sounds like your neck of the woods is a lot more liberal than mine. Sounds like it's more fun too. :-)

  • Yes im in EMT basic and I was surprised about this skill also. I actually took my national regisrty test and not sure if I passed yet. But this was one of our skills we have been practicing. We just dont use the laryngoscope, we just the tongue jaw lift and then insert the tube in that way.

  • If an EMT attempted this, they'd get their ass chewed by so many people that the subsequent firing and lawsuits would be inconsequental.

    Otherwise, pretty informative.

  • I took EMT this fall and for some reason it was in the book, but it's not a Basic skill. Well at least not in California. It should be since it's easy to do.

  • yeah the concept of intubation seems simple but its a fairly hard skill to master, if you have never done it in a tiny bathroom with 5 people in it and your patients head is up against the wall and they weigh 350 lbs and has puked all over then you cant say its easy

  • Just became a basic skill here in Louisiana, going through the course now.

    It was introduced into the EMT Basic curriculum mid semester this past fall.

  • uh, ET intubation is NOT a basic skill.

  • Excellent thanks for sharing this! Training video is hard to come by and this is a very good example indeed.

  • thanks for ur reply..

  • could it be done to patients who r conscious? without being anesthesized

  • No. You don't do it on someone with a gag reflex.

  • very well done! thanks for posting this, its a great refresher.

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