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I gels best airway control kit ever?

Medic99

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#41
I recently attended a course where I was introduced to the i-gel. It appeared easier, quicker and more effective than an LMA (I have never been fond of LMA's).


I feel the i-gel certainly has a place in pre hospital care and is another valuable airway option. It was interesting to see insertion done whilst ECC where being continuously performed during an arrest scenario.



I agree that ET is still the gold standard in airway management. Also I noted that drug administration was not indicated via the i-gel, unlike ET tubes. I was advised on the course that an ET tube could be blindly inserted through an in situ i-gel. I am yet to fully look into and practice that though.



From an operational stand point where there are often limited operators with EMT training/experience and transport/time critical patients; its a good thing. I think it will add a new skill and capability for EMT B/I in airway management.



NP/OP have a role, but I always attempt to apply best practice if it does not mean compromising the patient and lead to deterioration; ie if the circumstances and time permit secure the airway with an ET.



I have refresher training on the Emergency Airway Management Course at Singapore General Hospital next month. I will take an i-gel and speak to the staff there and see what their opinion is.



In summary, the i-gel is quick, easy to use, and easy to teach……. I rate it.
I'll assume that ECC is CPR over there... I just ran a CODE and was able to drop an ET tube successfully while active compressions were occurring on an 86yr old lady... So.... and not entirely sure bout how the process of dropping an ET tube through an I- gel, but if you insert a King LT airway and it is properly seated, you can pass a bougie tube through it which will exit the ramp and into the trachea, you can then remove the King over the bougie and slide an ET tube down the bougie into the trachea... So it may be possible.
 
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NeuralNet

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#42
I'll assume that ECC is CPR over there... I just ran a CODE and was able to drop an ET tube successfully while active compressions were occurring on an 86yr old lady... So.... and not entirely sure bout how the process of dropping an ET tube through an I- gel, but if you insert a King LT airway and it is properly seated, you can pass a bougie tube through it which will exit the ramp and into the trachea, you can then remove the King over the bougie and slide an ET tube down the bougie into the trachea... So it may be possible.
I assume ECC is External Cardiac Compression

I also assume the i-gel lumen is approximately the same size.

So the method sounds good

nice one

NN
 

Brethren

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#43
I'll assume that ECC is CPR over there... I just ran a CODE and was able to drop an ET tube successfully while active compressions were occurring on an 86yr old lady... So.... and not entirely sure bout how the process of dropping an ET tube through an I- gel, but if you insert a King LT airway and it is properly seated, you can pass a bougie tube through it which will exit the ramp and into the trachea, you can then remove the King over the bougie and slide an ET tube down the bougie into the trachea... So it may be possible.
Have you used a i-gel?..... For where I am working it’s a great bit of kit. Advising non English speaking medical staff (that historically place IV access above airway management) and rescue workers it’s sound and simple (no cuffs to inflate - which can be an added stress or poblematic to the less confident). BTW in china every sick person gets a “drip†as priority. ECC = External Cardiac Compressions. ETT in situ without out stopping compressions – you must be a jet! Well done. I still rate the i-gel and believe it has a place in securing an airway early and quickly. I agree with the forum originator.
 

Medic99

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#44
The company which I work for issues them as part of our vehicle trauma packs. We've been carrying them for over 4 months now. I personally haven't seen it used on a real casualty, but we do incorporate the use of it in to our weekly med training as a primary means of maintaining an airway in severe trauma cases.

Another excellent piece of med kit which we are now issued with is the First Access for Shock & Trauma“ (F.A.S.T.1) device.
Actually the F.A.S.T. 1 sucks... It's archaic, too limited, too many pieces, too easy to screw up... should be looking at the B.I.G. IO and/ or the EZ IO... Now I know why I have such a hard time finding a contracting job... I'm too knowledgeable and overqualified....
 

Medic99

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#45
Brethren:
eh, actually was kinda lucky... But my policy is always to take a look while CPR is in progress (gives you something to do while you're waiting for the 30 compression cycle to end), if I can see the cords then I've prob got a good shot when CPR stops (but why not take the shot anyway), but if I can't even see the cords then maybe the next cycle of compressions can be spent evaluating whether using an alternative airway would be more beneficial.
 
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Eddythespade

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#46
Hiya guy's,

It took me two days to read all the posts on this thread. lol

Im an Anaesthetic ODP and have been discussing the comments posted on here with various Consultant Anaesthetists. The general thinking is that IGels are "NO" different to any other LMA except that you have to inflate a cuff, and any monkey can do that. If an LMA has to be used, the Supreme LMA used with a Ryles tube and gastric bag would be the way forward. Supremes are used routinely for patients who need to be ventilated in theatre or who suffer from minor gastric reflux.

If it gets to the point that a person can except an LMA (with loss of gag reflex) the person is probably unlikely to survive anyway. A survey was undertaken of 340 people who had been intubated without induction agents and muscle relaxants. Out of the 340, 339 died and only one survived.

Please don't get me wrong that we shouldn't try, that is not what im saying at all. I think possibly that a surgical airway might be the better choice for the majority semi-concious patients. However, its all down to the skill setting of the individual.

Im really enjoying the site and the threads.

Kind regards,

Eddy
 

Starlight

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#47
Hiya guy's,

It took me two days to read all the posts on this thread. lol

Im an Anaesthetic ODP and have been discussing the comments posted on here with various Consultant Anaesthetists. The general thinking is that IGels are "NO" different to any other LMA except that you have to inflate a cuff, and any monkey can do that. If an LMA has to be used, the Supreme LMA used with a Ryles tube and gastric bag would be the way forward. Supremes are used routinely for patients who need to be ventilated in theatre or who suffer from minor gastric reflux.

If it gets to the point that a person can except an LMA (with loss of gag reflex) the person is probably unlikely to survive anyway. A survey was undertaken of 340 people who had been intubated without induction agents and muscle relaxants. Out of the 340, 339 died and only one survived.

Please don't get me wrong that we shouldn't try, that is not what im saying at all. I think possibly that a surgical airway might be the better choice for the majority semi-concious patients. However, its all down to the skill setting of the individual.

Im really enjoying the site and the threads.

Kind regards,

Eddy
Yep, so tell us all something we don't already know.

Most of us mere 'single celled pond life' work with very limited kit in some pretty fookin awful places, and not a nicely preped NHS hospital with the advantage (or not) of a consultant gas monkey to ask when things go tits up.

And how much kit do you think we can get in one fookin grab bag. The reasons I-Gels are favoured is exactly because you don't have to fook about inflating a cuff of an LMA, plus there's no chance that the cuff's knackered just when you really need the thing in anger.

I could go on, but I'll leave it to others because you've made my FOOKIN EYEBALLS BLEED.
 

Phecta

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#48
And how much kit do you think we can get in one fookin grab bag.
Should get loads of kit in your small bag, didnt you ever have the lesson of the never ending compo ration box in basic training where so much food was pulled out of the ration box on the big table that had a large cloth covering it?

Trouble is when you get in the real world, that bloody rat pack never has as much as what the instructors had in Basic Training lol
 

Eddythespade

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#49
I didnt mean to cause offence "Starlight"!!!! When it comes to pre-hospital care im sure you guys are carrying what you need and think is most suitable for the job and environment that your in.

I was just trying to add my "Two pennies" worth of ten yrs experience of advanced airway management that there is a better LMA than an IGEL.

The reasons I-Gels are favoured is exactly because you don't have to fook about inflating a cuff of an LMA, plus there's no chance that the cuff's knackered just when you really need the thing in anger.

Talk of how difficult it is to blow up an LMA cuff is just sheer "Nonny" to me. How difficult is it really to squeeze a twenty mill syringe of air!!! You must have been really really unlucky to have had a cuff fail on you, or your getting through loads of them!!!! I must have used thousands now and never had one fail to inflate.

Supreme LMA's are smaller than Igels, ryle tubes and gastric bags are flat so I imagine 1 could be fitted in to a bag.

Kind regards,

Eddy
 

Phecta

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#50
to be honnest, the most secure airway management method is Endo-Tracheal Intubation, this skill is not difficult to learn, the only thing that makes it difficult is the Royal College of Anaethnatists as they seam to want to protect their profession and justify large wage packets.

you can train 15 yr olds to intubate, and secure a tube in place, so perhaps the call should be comming out to train all medic operatives to be able to perform this skill.

When you are moving casualties then a secure ET Tube will give a good airway where as an I-gel or LMA will move. the trouble is that a lot of people advocating use of LMA and simular tubes have only used them in locations where casualties are not thrown around as they are moved to a vehicle and then bounced around down a dirt track.

perhaps there should be a discussion on airway management in the pre-hospital field in hostile environment setting as oppose to in the UK setting.
 

MEDFF

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#52
Bloody excellent posts to this,

Just to add.
I was told by a hosp resus officer 3weeks ago, that igels are now in the hands of
first responders (nhs amb trust). Someone must have signed the chit
 

Mountainman

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#53
Not my service. They're lucky to get OPA's. LOL. They've only just allowed EMT's (Formally IHCD Techs) to use LMA's.
 

Mountainman

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#54
To go back to this old thread I've done several arrests over the past two weeks and I've had two occasions when I've been unable to get an LMA to sit correctly and ended up having to properly tube the pt. Not my technique I can assure you. Still waiting to get igels. Not on the scene here yet.
 

Trojan631

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#55
I carry these in my practice and swear by them, so easy to use and a seal that is appropriate for the pre-hospital setting..
 

Seadog

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#56
I've only started using iGels regularly in the past few months, but am rapidly becoming a convert. Good seal which improves as it warms up, no cuff to tear on the teeth or deflate at the wrong moment when something happens, and very stable in the mouth.
 

kevinsmith1002000

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#57
I am a UK paramedic / PSO and I have used I GEL's many times pre hospital. They have one problem. If you need to man handle your patient to move them any distance they can quite easily become dislodged and it can also be difficult in a pre hospital environment to keep them patent if the patient aspirates (vomits). They are an excellent piece of kit in the correct circumstances but personally I feel that if you have the skill and time / situation permitting then an ET tube is the golden standard.
 
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