What really gets me excited about RSIs now is a new tool called the McGrath laryngoscope. Have you heard of it? It's a digital camera with the lens at the end of the blade. The thing is AMAZING. I first saw it in action when we were having trouble securing the airway of a patient in CCU who was in severe respiratory distress and the ED MD could not, for some reason, visualize the vocal cords with a standard laryngoscope. We were getting ready to do an emergency cric on the patient when the anesthesiologist shows up at the last second, whips out a McGrath laryngoscope, and slips a 7.5 down just as neat as you please. He totally saved the day!
He showed me how the McGrath works. He says it had saved a lot of patients from getting "criked" since he started using it. My hospital evidently saw its potential benefits, too. Now our ED, OR, and CCU each have McGraths as standard equipment in our difficult airway kits and it has become the tool of choice, with only a few exceptions where the blades are not long enough.
And here's the real kicker: the guy who invented it wasn't even in the medical profession. McGrath was an engineering student in the UK, and IIRC his capstone project was to invent something. He looked for an opportunity to invent something that would benefit people, and somehow decided to try and improve intubation techniques.
Mr. McGrath came to America last year to assess the effectiveness of his invention, and he actually visited my hospital a few months back. We showed him the statistics r/t before and after getting his laryngoscope. The contrast was stunning. The MDs and anesthesiologists also presented the areas where the McGrath was not effective (longer airways and hyper-morbidly obese patients. He took notes. A few months later, we got new McGrath blades that incorporated his revisions to accomodate the problem patients.
A friend of mine who is an anesthesiologist told me that Mr. McGrath was totally blown away about the effectiveness of his brainchild. She said that McGrath was one of the most self-effacing, humble, genuinely nice people she has ever met. I don't think that McGrath will ever realize how many lives will be saved by his invention. I think there's a special place in heaven for the guy.
But I digress from the subject.
From my particular point of view as an Emergency RN, I have found that even a bad airway is better than no airway at all. At least it's a start. And if a patient is in cardiopulmonary arrest in the field, then an emergency airway should be obtained. LMAs are good, but the rationale that intubation is preferable if it can be done safely is, IMO, a sound one.
There is variation among regions regarding the skill of medics. I think that it would be a good thing to assess the training and skill of each ALS medic and to provide enhanced training for those medics who do not demonstrate proficiency in securing an emergent ETT in field conditions. Maybe providing the McGrath would improve things. Anyway, that's my long-winded response. Have a great day, Doc. Cheers! /Gunner
I’m sorry I misspoke I think RSI should only be done in a fully equipped hospital, not in the field. If you dont have a good airway in the field, I think paralyzing the pt has a lot more potential for making things worse than better.
In a hosp with ED personnel and back up from anesthesia it is a different story. I did not mean to exclude the ED from acceptable places for RSI. I also think the LMA is a good thing. It is brainless enough even I can use it with success!
Have a great week!
That Mcgrath laryngoscope is so amazing and interesting! I never heard of it...you are a wealth of info!!! thanks :)