In What Circumstance Would It Be Appropriate To Use A Tourniquet
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TX, United states | Posted: iv/2/2022 ten:29:26 AM EDT The following is a very serious question. Mrs Rabinowitz is highly sensitive to sure insect bites. I have seen her become into anaphylaxis. We continue an epi pen handy. She also has but one working vocal string. A viral infection years ago left ane of them frozen in the open position. The insertion of a wire into that cord allowed the surgeon to adjust information technology to a near airtight position then she was able to speak in the normal voice subsequently 5 years of existence able to either whisper or scream only not talk in a normal tone. This created another problem. If she aspirates food or h2o, her other cord tin can spasm causing her to find it very difficult to breathe. Aspiration is a problem because with the frozen string, it can exist very difficult for her to clear her pharynx. We have discussed the possibility of an emergency trach if her throat was to spasm shut as a result of anaphylaxis or some other trigger and emergency care wasn't correct around the corner. Heaven foreclose this happen. But I have seen her go from perfectly fine to swollen and rashy in a matter of a couple of minutes. While nosotros could in practice simply use a sharp knife and a straw or a ball point pen body, I'd rather have something purpose designed. Is this likely? No. Only I've had so many things of a sudden happen to me in my life that I never experience entirely secure that tragedy is waiting effectually the corner. Is there a kit available on-line worth getting? |
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FL, Usa | [Final Edit: redfish86] Training, you need it. No offense. I'k not trying to be a smart ass here but whacking a pigsty in my wife's throat seems like something I'd similar to know how to practice actually really well, way in advance. I'thou not sure they cover stuff similar this in basic FA classes. |
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OH, USA |
Medical professional person. Yous are going to impale her from claret loss before suffocation. This is a terrible thought. Buy a 2nd or third epi pen. Also the phrase "throat closes upwardly" is stupid, the allergic reaction will be systemic and a trach wont do shit if the swelling is lower in the airway than your hole you hastily cut. You may even exist arrested if you bear witness upwardly to the ER with a stab wound in her neck. Yous should not do this, this is a terrible thought. |
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Usa | [Last Edit: 32ACP] Isn't you wife an OR RN? Maybe she should ask one of her colleagues. IME/IMO, "kits" fail in the hands of "trained professionals" enough, that with near thirty years of surgical experience—I don't use them. |
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CO, The states |
Cric not trach Sentinel youtube vids 6 et tube Im not giving medical communication |
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MO, United states |
Scalpel, finger, and a half-dozen.0 tube is all yous need. |
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Usa | [Concluding Edit: fish223] If you really desire to have that adequacy, you need an emergency cricothyrotomy kit. They are available in a few designs, and training is straightforward. As long as you know information technology'south a final ditch, holy shit gonna die otherwise kinda thing, I could see having it. They are very pocket-sized, and easy to carry, I saw a keychain version in one case. |
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USA |
Originally Posted By 32ACP: IME/IMO, "kits" fail in the hands of "trained professionals" plenty, that with almost xxx years of surgical experience—I don't utilise them. Agreed. My idea was strictly all else has failed, no help available, would I be happy if it was in my pocket or glove compartment, or FAK |
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TX, USA |
Originally Posted By Nootropics: @Nootropics Yous're correct. It is better to let someone die that to even countenance the idea of such things. As well I am certain that I would be stabbing her every so oftentimes only for practise. Just for the record, Mrs Rabinowitz has seem more than a few life saving trachs done in her 40 straight years as an OR RN. But, hey, if we programme for emergencies no matter how remote, nosotros are asking for trouble. I guess we all tin stop carrying starting time aid kits. |
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TX, U.s. |
Originally Posted Past fish223: @fish223 Thanks for your reasoned respond. I am talking last ditch. But then y'all and I aren't willing to sentry our loved one turn blueish and die. |
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MS, Us |
Good luck on your search. |
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OH, U.s. |
If she's that high of a gamble for aspiration, she should seriously consider a tracheostomy with a fenestrated inner cannula and an inflatable cuff. When she's ops normal, she tin have the cuff deflated and with a Passy Muir speaking valve, she'll have a relatively normal vocalisation. With the cuff inflated and a non-fenestrated inner cannula inserted, she'll take a protected airway from aspiration. |
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OH, USA |
I've watched docs in controlled environments fuck up trachs/crichs… It's easy to talk virtually, difficult to perform. I wouldn't recommend doing information technology. |
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USA |
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OH, Usa |
Originally Posted By TontoGoldstein: @Nootropics You lot're right. It is meliorate to permit someone die that to fifty-fifty countenance the idea of such things. Also I am sure that I would be stabbing her every then often just for practice. Just for the tape, Mrs Rabinowitz has seem more than a few life saving trachs done in her forty straight years as an OR RN. Simply, hey, if we programme for emergencies no affair how remote, we are asking for problem. I guess we all can stop carrying first aid kits. Cool, I as well work in surgery. I accept seen thousands of surgeries, maybe fifty-fifty tens of thousands. Prolly aint gonna pack a toolkit to crack the chest and filet open the belly on the street to look for a bleeder after someone gets stabbed. Im pretty sure a trauma surgeon wouldn't even entertain that themselves. But you lot exercise y'all. Youre asking the departure between holding pressure(Equivalent to an epi-pen) and fileting someone open up at home to notice the bleed (equivalent to the trach). Its asinine. |
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BIH |
Would a nasopharyngeal tube be a better selection, or practice those not reach far plenty? |
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Us |
Originally Posted By Nootropics: Mind, not trying to be a hardass, merely I don't think those ii scenarios are remotely equivalent. |
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TX, U.s.a. |
Up and downward. Not side to side. |
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TX, U.s.a. |
Originally Posted By fish223: Listen, not trying to be a hardass, but I don't remember those ii scenarios are remotely equivalent. Like push button |
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USA | [Last Edit: fish223] neat kit, but uses a scalpel, hook, and tube. A Rusch quicktrach cricothyrotomy kit is fashion, style easier. Experience the landmark, stab, secure. like this |
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TX, USA |
Is that needle catheter what the air is flowing through? |
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U.s. | [Terminal Edit: fish223] Originally Posted By Lug1: Large bore needle every bit a trocar, establish landmark, insert, secure, remove trocar, attach flex, and hit the bag. edit for clarity, no the needle comes out, bag goes on the plastic, or the flex adapter. |
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TX, USA |
OK I am seeing sizes. If it were me I would opt for the four.0 size. Our European monetary system manager, an ER dr. with a whole lot of initials by his name, is a house laic in a larger lumen airway for these types of things. The onetime needle crichothyrotomy where the lumen was nigh the same size every bit the needle roughly did non feed enough air without a positive pressure level device. Yous need some diameter to a tube to become enough air to back up life. I would exist very skeptical with a 2.0 for an adult. I am a trained chimpanzee though, simply regurgitating what our doctor has shown us. |
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USA |
Originally Posted Past Lug1: If it were me I would opt for the iv.0 size. Our EMS manager, an ER md with a whole lot of initials by his name, is a firm laic in a larger lumen airway for these types of things. The old needle crichothyrotomy where the lumen was about the same size as the needle roughly did not feed enough air without a positive pressure level device. Yous need some bore to a tube to get enough air to back up life. I would be very skeptical with a two.0 for an developed. I am a trained chimpanzee though, only regurgitating what our medico has shown us. I think they marketplace the two.0 for peds employ |
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TX, United states |
Originally Posted By fish223: I think they market the 2.0 for peds apply Rock on. Thanks for the insight. I was instructed in paramedic school anyone who would reasonably appear to be adult in stature should never go less than six.0. I take only used smaller than that on peds. And on that annotation, I have never missed an intubation in the field, and that comes with some good stories of GSW's and blind nasal intubations in odd places like upright in a driver seat of a car. |
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GA, Usa | [Concluding Edit: GAhunter95] |
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VA, The states | [Final Edit: jollyg83] Originally Posted Past TontoGoldstein: @fish223 Cheers for your reasoned reply. I am talking last ditch. Merely then you and I aren't willing to watch our loved 1 turn blueish and dice. Originally Posted Past TontoGoldstein: Originally Posted By fish223: @fish223 Give thanks you for your reasoned respond. I am talking terminal ditch. Simply and then yous and I aren't willing to lookout man our loved 1 turn bluish and die. Are you willing to lookout your loved one drain out because you cut her pharynx? I've been a paramedic for ten years. I've performed 2 crics in the field. I'k trained on it, I've practiced hundreds of times only it is nonetheless one of the scariest procedures y'all can do as a trained professional. Hell I've seen doctors screw it upward in the ER. Do Not Exercise IT AS A LAY PERSON. Even if it goes smoothly, yous better take ii suction units going full blast to articulate all the blood out so you can even find your land marks. I can't even begin to draw the corporeality of blood you'll exist dealing with even when things go right. DO NOT ATTEMPT A SURGICAL CRICOTHYROIDOTOMY UNLESS PROPERLY TRAINED AND CERTIFIED. |
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NY, USA |
My e kit has everything only a trach and I don't arraign yous for worrying at all. I would exist concerned in the same state of affairs, and would most likely seek advice every bit well. There would be nothing worse than watching someone die in front of you considering you didn't have the tools or training to assistance. As mentioned by others, it seems like y'all've got the name of the right kit.. Buy a training book on the procedure and read it comprehend to cover a few times. Open a kit and become familiar with its contents. Buy and keep multiple appropriate scalpels for the procedure. Hell, I'd purchase a few different training books to make certain you don't miss something important. I take a local independent pharmacy that sells anything in the globe over the counter. I had to buy a catheter kit because my bladder was blocked by a claret jell from a stent in my kidney. Information technology was uncomfortable, but it saved me eight hours at a local er. Adept luck! |
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WA, USA |
Yes, ARFCOM is the outset place I become for medical information .... |
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OH, The states |
Originally Posted Past anti_communist: Welcome back. |
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USA | [Last Edit: 2ndamendmentknights] No one is going to sell the laymen an emergency airway kit for liability reasons I would assume, only I'm sure yous can find them I wouldn't even consider it if I were you and I say this as someone who tin perform an emergent Cricothyrotomy. |
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CA, USA |
Originally Posted By redfish86: No offense. I'm non trying to be a smart donkey here but whacking a hole in my wife'south throat seems like something I'd like to know how to do really really well, way in advance. I'yard not sure they cover stuff similar this in bones FA classes. I had the grooming as a paramedic and never felt comfy with it. Nosotros cut on manikins, a person thrashing about would actually make it tough. Our department dropped the concept considering there was only one documented case in a year where it was needed. This was in Los Angeles County so there were plenty of ems calls for instance studies. |
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TX, USA |
Originally Posted By smarquez: I had the training as a paramedic and never felt comfortable with it. We cut on manikins, a person thrashing most would really arrive tough. Our department dropped the concept because there was merely one documented instance in a twelvemonth where it was needed. This was in Los Angeles County so in that location were enough of european monetary system calls for case studies. Never seen 1 done on a person thrashing most. They are rare and not needed often. |
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MI, U.s.a. |
Originally Posted By anti_communist: Because this thread has multiple Drs and paramedics posting in it, it'south not a bad choice. |
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NY, USA |
I know... People here accept below average intelligence levels... |
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OR, USA | [Final Edit: Throwsabender] This thread is relative to my interests. I accept what I call back is called laryngospasm episodes. Information technology is scary as fuck non being able to draw a breath. It happens when drinking water and goes to incorrect pipage. Add together. Take to step out will check back. |
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SWE | [Last Edit: jagleaso] I do at least 1 trach per week and have just had to do emergent cric iv times in my life. |
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USA |
A needle cric is washed by paramedics, so with some training, this might exist an option. I've done exactly 3 emergent crics in ~30 years of surgery—massive facial trauma; angioedema on a guy with a BMI of fifty+ & a lost airway on an "elective" difficult airway. Anyone who claims it's a "common procedure" is either a liar, does them unnecessarily or is a surgeon working in austere circumstances with minimally-gifted anesthesia providers. Tanto— if you lot decide to practise this, please sign up for an ATLS course with either an animal lab or cadaver lab. I get where you lot're coming from, OP, just doing your first cric on your married woman in a literal life or death situation may kill her if she has haemorrhage into her airway. That'southward all I got. I've said information technology before here—tools in a kit without training or practice is like buying a guitar & maxim you're a "theoretical musician." |
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AR, USA | [Last Edit: ISED8U] The Cric-Primal system isn't cheap, but it's probably the virtually straight forward and user friendly system on the market place. This is the kit that I'g issued for duty (it'south a role fourth dimension pre-hospital volunteer position). My normal job the by 20+ years has been performing anesthesia, then airways are kind of my thing. Roughly 1/3 of surgical airways done in the field Fail....and people die. You will need more than just good intentions to perform a cric. If you're going to perform a cric you should take some advanced airway training and alternatives to a surgical airway at your disposal. Failed To Load Title eta: sp |
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IN, The states |
Originally Posted By TontoGoldstein: @Nootropics You're correct. It is better to let someone dice that to even countenance the idea of such things. Also I am sure that I would exist stabbing her every so often only for practice. Just for the record, Mrs Rabinowitz has seem more than a few life saving trachs done in her xl straight years as an OR RN. Merely, hey, if we plan for emergencies no matter how remote, nosotros are asking for trouble. I judge nosotros all can cease carrying first help kits. This seems like something y'all should be asking her doctor...not the internet. |
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MO, U.s. |
I've seen the process on tv, simply I'g not Jake Greene on a school bus or a medic in the back of a speeding ambulance so I'll just say no... |
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TX, USA |
I estimate we saw in this thread the people who don't read. I was articulate. Last result. LAST RESORT!!! Mrs R knows hundreds of med pros. Do you think we sought to approach this in a coincidental manner? If she is turning blueish and help is not near, am I expected to watch her choke, suffer brain damage, or fifty-fifty die because there might exist blood? I guess we shouldn't have a turniquet (sp) because haemorrhage out is better than possible tissue damage? GD never ceases to amaze me. |
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IN, USA | [Last Edit: Burnsy] Originally Posted By TontoGoldstein: Mrs R knows hundreds of med pros. Practise you lot retrieve we sought to arroyo this in a casual manner? If she is turning bluish and aid is not near, am I expected to scout her choke, suffer encephalon damage, or even dice because there might be blood? I guess we shouldn't have a turniquet (sp) considering bleeding out is amend than possible tissue harm? GD never ceases to amaze me. What did those med pros say when y'all asked them? Why would you ask completely random people near doing this...people who range from welders to accounts, instead of the person(s), who did the surgery on your wife and/or know her exact situation? Considering she likely has some very knowledgeable experts who know all the details of what she is dealing with, request complete strangers is an odd pick. |
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TX, U.s.a. | [Last Edit: AKoch31] Originally Posted Past TontoGoldstein: Mrs R knows hundreds of med pros. Practice yous think nosotros sought to approach this in a casual manner? If she is turning blueish and help is not near, am I expected to watch her choke, suffer brain damage, or even die because there might be blood? I guess we shouldn't have a turniquet (sp) because bleeding out is better than possible tissue damage? GD never ceases to amaze me. You have a large number of medical professionals telling you lot the verbal same thing. If you are not trained and have practice doing this, you lot're going to kill your married woman. Having more available epi pens is a FAR safer option than some random trying and emergency airway. Your wife is an OR RN, that's fine. That's as well completely irrelevant. I've been a role of more than avant-garde airway situations than I can call back working in a predominantly pulmonary ICU and emergency department. What you lot're considering is dangerous and incredibly naive. Yous take other options and it would be foolish for you lot to ever try this. The fact that you're even comparison a tourniquet and tissue damage to an emergency airway and the consequences of fucking that up tells me everything that I demand to know. Your may recollect you're being prepared, but you lot couldn't be further from the truth. |
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OR, USA |
Originally Posted Past TontoGoldstein: Mrs R knows hundreds of med pros. Do you call back we sought to arroyo this in a coincidental manner? If she is turning blueish and aid is not near, am I expected to watch her asphyxiate, endure encephalon damage, or even die because there might exist blood? I gauge we shouldn't have a turniquet (sp) considering bleeding out is better than possible tissue impairment? GD never ceases to amaze me. I understand your frustration considering I have have seen the terror in my wife's optics during my episodes. But I recollect some of these guys accept excellent points from a clinical indicate of view. I hope we can find some sort of answer. |
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USA | [Last Edit: ipsilateral_7] Originally Posted Past ISED8U: Roughly i/3 of surgical airways done in the field Fail....and people die. You will need more than just good intentions to perform a cric. If you're going to perform a cric you should have some advanced airway training and alternatives to a surgical airway at your disposal. eta: sp And another 1/3 of field airways have catastrophic complications. I've seen damn good docs have complications with perc trachs in a not-rushed non-chaotic environment If you tin't intubation and have several methods to do then a surgical field airway is a bad thought. As someone who'south washed them, I could non imagine trying to exercise a cric on my wife and having it cease well. OP would be amend off with a LMA or combitube or king airway and an ambu bag |
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https://www.youtube.com/picket?v=N0gOrKlaa6w|
FL, Us |
Rusch is designed to work with very high flow O2 and a handbag. At minimum I am guessing a BMM is ameliorate than zip? Wouldn't a BVM and OPA or NPA solid basic skills (and some epi) exist the best option for someone with piffling to no preparation. Fifty-fifty cylinder of O2 is non perishable and piece of cake to obtain and utilize |
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TX, USA |
Originally Posted Past Burnsy: Why would you ask completely random people about doing this...people who range from welders to accounts, instead of the person(s), who did the surgery on your married woman and/or know her verbal state of affairs? Considering she likely has some very knowledgeable experts who know all the details of what she is dealing with, asking complete strangers is an odd choice. Except yous accept none of those people doling out advice in this thread. Yous have known medical professionals posting with different points of view. GD tin can be a mess, only there are some people hither who can come through. Knowing how to cut through the signal to noise can get a long style. I don't see that he has washed anything questionable hither, much less wrong. Just my opinion. He also has e'er seemed like a very smart guy. I am gonna guess if he does pursue this he won't accept it lightly and will get appropriate training. |
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IN, USA | [Last Edit: Burnsy] Originally Posted By Lug1: GD can exist a mess, merely there are some people hither who tin can come through. Knowing how to cutting through the signal to noise can go a long way. I don't see that he has done anything questionable here, much less incorrect. Just my stance. He also has always seemed like a very smart guy. I am gonna guess if he does pursue this he won't take information technology lightly and will go appropriate training. Ok. Don't enquire her doctors who know exactly what her situation is and how to best approach the state of affairs that OP is worried about. Enquire the a gun forum. |
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Usa | [Terminal Edit: broadrunarms] You would need a emergency cricothyrotomy kit, equally others said. Even paramedics don't to emergency tracheotomy and no all do emergency cricothyrotomy. Or are you masking the desire to slit her throat? |
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TX, USA |
Originally Posted By Burnsy: Ask the a gun forum. Or as he seems to take stated Inquire BOTH? Is that wrong? |
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In What Circumstance Would It Be Appropriate To Use A Tourniquet,
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