Endo tracheal intubation or LMA's?

Discussion in 'Professionally Qualified, RAMC and QARANC' started by comedy dave, Aug 21, 2003.

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  1. Seeing now that the NHS has moved towards favouring the LMA as a secure means of airway management, has the AMS gone the same way? And are they now stocked and carried in Med Regt's/Sqns?
    Personally I think they are more harder to apply, however they do have their place, and less traumatic for the patient post recovery.
    I prefer the ET tube as gold standard airway management.
    Any thoughts?
  2. we had LMAs in military hospital years ago, i was at Woolwich (them were the days) when they first came out, and they are used in places such as R3MIMU in Bosnia, and on a recent deployment with 3CSMR to Africa we had them in our Anaesthetic module. Field hospitals have them obviously cos the modules are alledgedly identical.
  3. I would have to agree with Comedy Dave that ET is the Gold standard especially during the immediate management of Post Trauma but in a clinical environment ie in theatre then the LMA is a superior peice of equipment (supervision) being the key. We started teaching the LMA back in 95 at Keogh.
  4. is the navy really that over run with LMA's that we can use them for airway management now!!!!
  5. cant use em once they get their PO though
  6. ET intubation may be the gold standard and essential in certain cases, such as head and neck surgery, crash inductions etc.. or due to the patient positioning, but you cant disagree that the LMA is at the end of the day 'kinder' to the patient, no scoline apnoea, no fasciculation pains, no post intubation sore throats.
    But only if the person putting in the LMA is competent at insertion, but then again, if youre not competent at intubation of the trachea youll cause a lot more damage with a tube and/or the laryngoscope than you ever could with a LMA.
  7. Theatreman, as an old CMT and nurse, I couldn't agree with you more, just because the kit is there, doesn't mean you are capable of using it.
    I saw this just too often, using kit because you had it.
    I had a soldier limp into my med centre, and because the medic that treated him went too far and used kit he had no right to use, the soldier went out on crutches.
  8. Theatreman

    What is scoline apnoea? I've heard of scalenes; the accessory muscles to breathing, so what is scolines? I've looked in medical dictionaries and can't find it.
    Enlighten me.

    Cheers dude.

    Comedy Dave
  9. Very true Theatreman, many nurses in the NHS these days are trained to use the LMA as part of the BLS course, there are very few nurses I know that have been trained to insert an ET.

    Scoline apnoea refers to the prolonged period taken by a patient to regain the ability to breathe after being given a standard dose of the muscle relaxant, scoline, during surgery.

    I'm sure Theatreman will expand further, as this is his area of expertise.
  10. Life Saver

    Thank, thats cleared that up. As a paramedic we don't put any one to sleep or administer muscle relaxant. (Only EP fits - stesolid and diazemuls)
    LMA's are good pieces of kit, our ambulance service doesn't use them. And I'm concerned of their use in the acute emergency setting. I.e, they do not guarantee 100% against aspiration of gastric contents and against high pressures of O2 administration. Hospital setting they are fine in elective surgery.
    An obese person in cardiac and respiratory arrest, LMA? I'm not so sure of. ET would be the weapon of choice I fancy.
  11. thanks life saver,
    as youve said scoline which is also known as Suxamethonium Chloride or Succinyl Choline is a depolarising muscle relaxant which is used for the intubation of the trachea, Scoline apnoea is caused by the bodys inability to produce pseudo-cholinesterase (an enzyme which destroys depolarising relaxants in the blood stream). About 1 in 3000 people lack this enzyme and the condition is usually hereditary.
  12. Good god theaterman, the above info gives the impression you know what you’re talking about.

    An ODP talking sense, wonders will never cease :twisted: .
  13. well i do have a hangover, might explain it!!
  14. A good nights entertainment & a reasonable sending of, I thought.
  15. yep, cant believe that you didnt play 'drunken draughts' (or however its spelt), probably a wise move my friend :twisted:

    Paid GI Jargon a swift visit, god theyre boring.