Le manufacturier recommande 24 heures Max ! Basé sur quoi ??? Et ça
C'est si le Combitube est en position Oesophageal Si il en position endotracheal Grandeur 11mm (Equiv.) 15cc dans le ballonet 30 minutes m'apparait un peu long Ceci dit On enseigne au Paramédiques/MDs De dégonflé le ballonet "trachéal" jusqu'a fuite Et de rajouté 1 cc Ceci se fait toujours, jamais, des fois, c'est pas ! ? Vous avez un "cuff gauge" en salle d'urgence ? Vous l'utiisez ? Les inhalos s'en occupe ? Charles ----- Original Message ---- From: Marie-Charlotte Koenig <[EMAIL PROTECTED]> To: [email protected] Sent: Thursday, June 21, 2007 4:58:19 AM Subject: URG-L: RE : URG-L: intubation prehospitaliere... Parlant de combitube Jocelyn, j'ai cherché de la documentation sur le temps qu'il était sûr de le laisser en place et n'ai rien trouvé . Les meilleures réponses étant il va de soi pas plus longtemps qu'il ne faut et le moins longtemps possible évidemment. MCk --- [EMAIL PROTECTED] a écrit : > > Attention, il faut comparer des pommes avec des > pommes, nos voisins du sud > font de l'intubation endo trachéale alors que nos > paramédics utilisent des > Combitubes. Cet article n'a donc aucune valeur dans > ce contexte. > > Cela n'enlève pas cependant la nécessité de > vérifier le A et le B, mais cela > demeure vrai dans toutes circonstances. > > JM > > In a message dated 2007-06-18 03:53:59 Est (heure > d'été), > [EMAIL PROTECTED] writes: > > > Je suis sur que nos super paramedics sont mieux > entraines que nos voisins du > sud... :) > Mais avec cette etdue, il y a de quoi nous pousser > encore plus a ne pas > hesiter a verifier le A et B lors d'une arrivee d'un > patient intubate > > Summary and Comment > Adult Prehospital Intubation: More Harm Than Good? > One quarter of intubated patients had unrecognized, > misplaced endotracheal > tubes in a study from the New York City emergency > medical system. > > Recent pediatric studies in emergency medical > systems with short transport > times suggest that prehospital intubation provides > no benefit or is even > potentially harmful, compared with ventilation > alone. In a prospective > observational study, researchers assessed the > frequency of unrecognized esophageal > intubation in 132 consecutive adult patients who > were transported to two New York > City emergency departments and had been intubated in > the field. Emergency > physicians confirmed tube placement by direct > visualization (71%), end-tidal > carbon dioxide detection (39%), or both. Tubes were > misplaced in 32 patients > (24%), with 20 tubes in the right mainstem bronchus, > 11 in the esophagus, and 1 > in the hypopharynx. Only one patient with a > prehospital esophageal intubation > survived to hospital discharge. Information was not > available on the > training and experience of the paramedics who > performed all prehospital intubations. > The researchers assessed reasons for deferred > intubation in a separate group > of 60 consecutive patients who were intubated within > 10 minutes after > arrival at the same hospitals. Prehospital > intubation was not attempted in 52% and > was unsuccessful in 22%. The most common reasons for > not attempting > prehospital intubation were short transport time and > suspected difficult airway. The > authors call for controlled trials to assess whether > prehospital intubation of > adult patients improves outcomes. > Comment: Adult prehospital endotracheal intubation > is yet another example of > a protocol that was implemented without prior > scientific validation of > outcomes benefit. Now that this procedure is > standard care, controlled trials > would be difficult to design and might face > challenges from research ethics > boards. However, the high rate of tube misplacement > found in this study — > consistent with rates reported in other systems — > is unacceptable. The key > prehospital intervention is oxygenation, not > necessarily intubation; other airway > management methods, such as use of laryngeal mask > airways, may be preferable to > intubation. Prehospital intubation requires > mandatory confirmation of proper > tube placement by end-tidal carbon dioxide > monitoring, which often was not done > in this study. EPs must immediately confirm proper > tube placement for all > patients who have been intubated in the field. > — _Kristi L. Koenig, MD, FACEP_ > (http://emergency-medicine.jwatch.org/misc/board_about.dtl#aKoenig) > > Published in Journal Watch Emergency Medicine June > 15, 2007 > Citation(s): > Wirtz DD et al. Unrecognized misplacement of > endotracheal tubes by ground > prehospital providers. Prehosp Emerg Care 2007 > Apr-Jun; 11:213-8. > > > > ____________________________________ > Take the Internet to Go: Yahoo!Go puts the _Internet > in your pocket:_ > (http://us.rd.yahoo.com/evt=48253/*http://mobile.yahoo.com/go?refer=1GNXIC) > mail, > news, photos & more. > > > > > > > > Découvrez ce qui fait jaser les gens ! Visitez les groupes de l'heure sur Yahoo! Québec Groupes. http://cf.groups.yahoo.com/ --- URG-L Pour quitter URG-L, envoyez un message a la liste ([email protected]) avec, COMME SUJET, le mot REMOVE (rien d'autre). --- URG-L Les archives de la liste d'echange sont disponibles pour consultation a l'adresse : <http://webmail.niveau3.ca/public/mail-archives/[email protected]>. L'acces est protege par mot de passe: usager: archives et mot de passe: archives Les archives antérieures sont disponibles a : <http://www.mail-archive.com/[email protected]>
