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The Doctors Lounge - Primary Care Answers

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Forum Name: Miscellaneous Student Topics

Question: ET


Jenniec - Tue Feb 24, 2004 6:59 am

If someone tried to ET a person while they were awake and well. Would Lidocaine work for numbing the vocal cords, how much would you have to use? How long would it last? How would you get it there? After attempts were made would the tissue in the throat be just sore? And if you intubated the Esophagus and blood came out with it where did the blood come from?
We were playing around in class and we had some problems...
Thank you
Jennifer
Dr. Yasser Mokhtar - Tue Feb 24, 2004 8:15 pm

Dear Jennifer,

Lidocaine will work to numb the vocal cords and abolish the gag response which is the most feared thing during intubation for fear of aspiration if the patient vomits during intubation.

Lidocaine can administred to the throat by spraying, using a gel like formulation that one can swalow and keep in the back of the mouth for a while and by a liquid formulation that could swished and gargled.

The effect of lidocaine is short lived, if you give a patient lidocaine intravenous, its half life is between one and a half and 2 hours.

About esophageal intubation and the blood coming out, it could be from any where because most probably this is trauma secondary to intubation attempt. Could be from teeth, tongue, throat or from the esophagus itself.

Thank you very much for using our website http://doctorslounge. com and I hope that this information helped.

Yasser Mokhtar, M. D.
Jenniec - Wed Feb 25, 2004 12:17 am

Great!!! We were trying to intubate each other in class, but we ran into problems right when the tube was going through the Vocal Cords. So I think we will use a spray next time. However, I wanted to ask. Is it safe to ET people that are awake and oriented? Does it matter how long you take in intubating them, I know it does when you someone that is unconscious…And what would be the safest way to do it?
Thanks
Jennifer
Dr. Yasser Mokhtar - Wed Feb 25, 2004 2:26 am

Dear Jennifer,

Are you med students? Are you doing this under medical supervision? Why are you trying to intubate each other?

If you want to learn how to intubate people to provide cpr in cases of emergency, there are courses held for cpr where you can learn how to intubate.

What you are doing is not the standard of practice and you might end up in real problems while doing this. Please, stop doing what you are doing unless you are under direct supervision of a medical doctor and yet I can not see a doctor trying to train people how to intubate using each other for training purposes.


Thank you very much for using our website http://doctorslounge. com and I hope that this information helped.

Yasser Mokhtar, M. D.
Jenniec - Wed Feb 25, 2004 5:31 am

Well,
I am going to go to Med school next year. Right now I am in a Paramedic Program, we are just having a …learning experience, mostly for fun during our free time. No we weren’t doing this with the supervision of a Medical Doctor. We have intubated before, and we know how to. But we have done it in an OR were everything is prefect…the patient is sedated and is limp, and the table is prefect reach. We were trying for something a little less controlled, like on the ground, mostly awake but not in an emergency situation. A few of us do not have or have very good control of the gag reflex and are able to sustain it to the point where a Laryngoscopy is possible with the Laryngoscope blade, but when going to advance the tube (I’ll use myself as an example) I start to get a little nervous and loose control of the reflex, then gag. So we got the great idea of using Lidocaine as a local anesthetic. We just didn’t know how to administer locally to the vocal cords.
I have the feeling that the program is a little more lax on training regulations then the Med schools. I was given a choice between having a ET tube done or a NG tube. I am just scared I would throw up with an NG tube and was promised that the ET tube would only be in for a few seconds.
Anyway,
would it still be unethical to go on? We were planning on trying it tomorrow after classes, but using a spray.
Thanks for your time
Jennifer
Dr. Yasser Mokhtar - Wed Feb 25, 2004 6:22 am

Dear Jennifer,

I would encourage you all not to do that. As a paramedic most probably you will have the opportunity to intubate people in non-perfect conditions a lot and I don't think that what you are doing now is the perfect way to practice non-perfect conditions intubations because still it is a somewhat controlled situation.

Intubations have there own risks and lidocaine as well has its own severe and serious side effects. So, something might happen and then you will get into real problems.

Training programs have regulations and rules and these were put by people who have thought aobut the best way to train students and I think that if they thought that using each other for practice would make people trained better, most probably they would have gone with it and I think you have to go by the rules even though if you think they are not good enough because if you break the rules and the life of a person is endangered or lost it is going to be because the rules were broken.

I would urge you not to participate in such activities.

Thank you very much for using our website http://doctorslounge. com

Yasser Mokhtar, M. D.
Jenniec - Wed Feb 25, 2004 6:44 am

Tomorrow I am supposed to be the student that gets E. T. ed. I tried it already on Monday…that is why I asked the questions about the blood and stuff on the topic page. We had complications. They hoped that after a few days my throat would be better so we could try again. If you really feel strongly that I shouldn’t I trust that, and will not do it again. However I fail to see how it could be too dangerous for us. Is it the drug that you are worried about or is it the complication of Intubating the wrong tube ( that happened Monday)
Anyway
Thanks for your time
Jennifer
Jenniec - Wed Feb 25, 2004 6:48 am

Well...if it makes a difference, Medical Control doesn't know about the Nitro testing thing.
Dr. Yasser Mokhtar - Wed Feb 25, 2004 6:49 am

Dear Jennifer,

I don't think that training this way is going to make you any better and I think that whoever is doing this is subjecting him/herself to unnecessary potential complications.

I can only give my opinion but I can not force you to implement it.

Thank you very much for using our website http://doctorslounge. com

Yasser Mokhtar, M. D.
Jenniec - Wed Feb 25, 2004 6:55 am

I was thinking about it, I don't think I will do that tomorrow...anyway The things we are doning like that are done without the approval of Medical Control. Do you think it would just be wise to not participate in things that are not approved though them?
Thanks
Jennifer
Dr. Yasser Mokhtar - Wed Feb 25, 2004 6:57 am

Dear Jennifer,

Yes, I think so because they put people's safety before anything else.

Thank you very much for using our website http://doctorslounge. com

Yasser Mokhtar, M. D.
Jenniec - Wed Feb 25, 2004 7:02 am

Sorry this was a question I had too...NG tubes, What is the difference on putting those down people other then the fact that they are smaller? Why do the teachers what to have the students do that?
My class ( won't have to because I tryed the ET thing already) is going to do it to each other.
Thanks
Jennifer
Dr. Yasser Mokhtar - Wed Feb 25, 2004 7:07 am

Dear Jennifer,

ng (nasogastric) tubes go down the esophagus to the stomach through the nose (nothing to do with breathing or using a laryngoscope), could lead to minor nasal trauma though, while et (endotracheal) tube goes down the windpipe and it could cause some damage to the vocal cords in addition to other side effects.

Thank you very much for using our website http://doctorslounge. com and I hope that this information helped.

Yasser Mokhtar, M. D
Jenniec - Wed Feb 25, 2004 7:11 am

Why are the teachers making the students do that?
Dr. Yasser Mokhtar - Wed Feb 25, 2004 7:13 am

Dear Jennifer,

I think that this question has to be asked to the teachers.

Thank you very much for using our website http://doctorslounge. com

Yasser Mokhtar, M. D.
emskyle - Thu Mar 24, 2005 2:20 pm

I understand that this post / topic is old but I feel compelled to post a reply anyway in case anyone else out there is even contemplating this. I am an Advanced Life Support Paramedic in Canada, and this question almost knocked me off my seat. I’m usually hesitant to criticize a peers practice but this ...
:shock:
What concerned me about what was being asked by this particular student was the extreme lack of knowledge about intubation and airway management. The student asked numerous questions but not one bordered on being an intelligent one. I want to reassure anyone who reads these postings, that the level of absolute ignorance illustrated is not reflective of the profession. I only hope that these questions were posted VERY early in this paramedic student’s education and that her class mate’s attempts at performing this advanced procedure was a sign of an eagerness to learn.
Web-Medic - Fri Mar 25, 2005 4:32 am

Idaho is a National Registry State as is Arizona. It isn't in the curriculum to intubate each other and it isn't in the State regulations for Paramedics to carry lidocaine for this purpose. My question is, where are they getting the lidocaine and under what Doctors orders are they using it? I would be willing to bet the Instructor doesn't know this is being done and if they do, they need to be severely reprimanded by the Medical Director because his/her license is on the line if someone gets hurt.
Jenniec - Mon Mar 28, 2005 5:44 am

Good Day to you all…I am sorry, I haven’t been on this site for a while and forgot about this posting until I received an e-mail this last week. As Emskyle comments are concerned, when we were playing around with this we were still in the “VERY” begging of learning about the airway system. The professors did know that we were doing with the lidocain and airway instruments, in fact they even encouraged it.
A little background on my questions…I was in the beginning of Paramedic School, and the youngest of my class (I was very gullible). The teacher had said that if we would attempt to stand an ET we wouldn’t have to try the NG tube. Honestly I was disgusted by the thought of having anything go down my nose so I and a few others opted for intubation. I was concerned about this because of all the soft tissue in the throat and the damage that could be done so I asked questions on here. NOTE: The Medical Director never did know that we did this and I am sure he would a more then a little mad if he knew the many things we did in that class. There were many things that happened in the class I took that were wrong and later I took some of those problems to higher authorities. Since then, the Paramedic Director no longer works here, and they are getting new teachers. Another NOTE: We got the Lidocaine, Nitroglycerin and Adenosine from one of the teachers who was a nurse.
I am glad I did ask that question because it is through questions that we learn what is wrong and right. While I was learning I am glad that someone that knows more then I was there to answer my questions and be concerned about that I was doing. (Thank you to the people that responded) I don’t know if I ever posted anything about Nitro but we used to drop out BP to see the effects (very stupid!!) The teachers and Program Director were removed do to my reporting after I posted questions and received answers that it was wrong
I did finish school…healthy and alive, did a paramedic internship at Grady and have moved on. There are new people in charge of the Paramedic Program I went through and a new Medical Director. Thank you for your concerns and comments. Like the Web Medic said the things that we did in that class are not reflections on the National Registry for Paramedics in the U. S..
Thank you again
Jennifer

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