SALT Airway?

Discussions of the best (or worst) equipment to have on hand for use in the event of an injury during an emergency.

Moderator: ZS Global Moderators

User avatar
Veritas
* * * *
Posts: 942
Joined: Sun Sep 16, 2007 2:21 am

SALT Airway?

Post by Veritas » Thu Oct 10, 2013 3:12 am

Anybody ever used this? http://www.mdimicrotek.com/prod_salt.htm" onclick="window.open(this.href);return false;

Tried it out recently in a workshop, it was interesting. Never used it on a person, wondering if anyone out there has?

It's not billed as a definitive airway by any means, but that's not the point. It's an interesting adjunct. I feel like it's an "intubating OPA." The big advantage I see is not stopping compressions to get a definitive airway. If it works in real life. Which I'm not sure it does. That's why I figured I'd see if it's been discussed before here or if anyone has used it.

Our prehospital adjunct of choice here is a Combitube for the most part, but we don't use those in the ED. You either get an OPA while we bag you to preoxygenate before the intubation or you don't need an airway, so I don't get to play with the fun gadgets much.
Veritas liberabit vos

FAK | IFAK || BOB | GHB

User avatar
DannusMaximus
ZS Donor
ZS Donor
Posts: 2767
Joined: Wed Nov 19, 2008 9:00 pm
Location: Indiana's Southern Coast

Re: SALT Airway?

Post by DannusMaximus » Thu Oct 10, 2013 8:33 am

Interesting gadget.

I didn't know such things existed prior to your post. We are done with combitubes as soon as we use up all our inventory, and will be using King tubes from then on. Sometimes our transport medics yank the tube we've already put in to put in a dedicated ET, sometimes they don't.

Would insertion of the SALT be an EMT-B level intervention or a paramedic level intervention, I wonder?
Holmes: "You have arms, I suppose?
Watson: "Yes, I thought it as well to take them."
Holmes: "Most certainly! Keep your revolver near you night and day, and never relax your precautions..."

- The Hound of the Baskervilles

User avatar
Calzonewdippingsauce
* *
Posts: 144
Joined: Sun Jun 10, 2012 10:30 pm
Favorite Zombie Movies: Dawn of the Dead, 28 Days Later, 28 weeks later
Location: South Central PA

Re: SALT Airway?

Post by Calzonewdippingsauce » Thu Oct 10, 2013 8:53 am

I am not too impressed with them. I recently took a critical airway management class where we reviewed many devices, adjuncts, and airway cameras that are being pumped into the market today. I have to say there are a lot out there, and this is one of them that sucks. This thing works great for doing one thing: intubating a manikin. We tested this thing out on cadavers and its just a PITA. There is no sure way that you are intubating the trachea, your doing it blind, and I think our success rate was somewhere in the 30s. This thing was developed to fit a manikin, and as we know, every patient in the field is different in size of anatomy. I am always skeptical of the "One size fits all and will put the tube where it needs to be 100% of the time" adjuncts.
Image

User avatar
DannusMaximus
ZS Donor
ZS Donor
Posts: 2767
Joined: Wed Nov 19, 2008 9:00 pm
Location: Indiana's Southern Coast

Re: SALT Airway?

Post by DannusMaximus » Thu Oct 10, 2013 9:08 am

Calzonewdippingsauce wrote:This thing works great for doing one thing: intubating a manikin.
That's funny stuff right there! :lol:
Holmes: "You have arms, I suppose?
Watson: "Yes, I thought it as well to take them."
Holmes: "Most certainly! Keep your revolver near you night and day, and never relax your precautions..."

- The Hound of the Baskervilles

User avatar
JIM
ZS Member
ZS Member
Posts: 1506
Joined: Sat Nov 10, 2007 8:30 am
Favorite Zombie Movies: Wall street (Dollar zombies FTL$)
Location: The Netherlands

Re: SALT Airway?

Post by JIM » Thu Oct 10, 2013 11:22 am

Meh, I don't like blind intubations, and it basically does the same thing as a LMA Fasttrach.
Image

First-Aid primer and medical disclaimer

"Trust me, I'm a Medic. This won't hurt.... Me. You, I'm not so sure - probably a lot..''

medic photog
* * *
Posts: 319
Joined: Wed Aug 08, 2012 10:47 pm
Location: PA
Contact:

Re: SALT Airway?

Post by medic photog » Thu Oct 10, 2013 8:25 pm

I had a medic student introduce me to the thing, said it was useful for difficult airways. I asked him why you'd want to stick more things in the way to obstruct your view knowing before hand that you'd have troubles securing a tube. I played with one in an airway lab and am also not impressed. Possibly as a rapid blind technique during an extensive vehicle rescue scenario, but otherwise, nope, just give me a stylette and a couple different blades, like maybe a Guedel or Wisconsin in addition to my Miller and Mac and I'm sure I'll be good.

User avatar
Veritas
* * * *
Posts: 942
Joined: Sun Sep 16, 2007 2:21 am

Re: SALT Airway?

Post by Veritas » Fri Oct 11, 2013 3:25 am

Dannus: Dare I ask why you are using only Kings now?

calzone: I totally see where you'd be correct. I just wasn't sure, I've never heard of anyone actually using one.

Jim, I agree. But it's always nice to have some sort of back up. What's yours?

medic photog: Yea, definitely not for a true difficult airway. But I wonder if it isn't a bad option to help ventilate in between attempts? Let's say you think you have a good view, some reason you can't pass the tube, so you're gonna try again? Meh, just hypothesizing. The scenario you posed I feel would be another good example, but then again I'm not a first responder.
Veritas liberabit vos

FAK | IFAK || BOB | GHB

User avatar
JIM
ZS Member
ZS Member
Posts: 1506
Joined: Sat Nov 10, 2007 8:30 am
Favorite Zombie Movies: Wall street (Dollar zombies FTL$)
Location: The Netherlands

Re: SALT Airway?

Post by JIM » Fri Oct 11, 2013 10:26 am

I start with good positioning of the head, good preoxygenation, bvm and a trained surgical team ;-)

But seriously, my backups:

- opa/npa
- cricoid pressure (BURP)
- bougie and/or stylet
- LMA ( we use Igels)
- mcgraft video laryngoscope
- mccoy blade
- trachlight
- fasttrach
-fibreoptic intubation
- melker set for cricothyroidotomy or retrograde intubation
- anesthesiologist, ENT surgeon
- and last but not least: aborting the planned procedure ;-)
Image

First-Aid primer and medical disclaimer

"Trust me, I'm a Medic. This won't hurt.... Me. You, I'm not so sure - probably a lot..''

User avatar
DannusMaximus
ZS Donor
ZS Donor
Posts: 2767
Joined: Wed Nov 19, 2008 9:00 pm
Location: Indiana's Southern Coast

Re: SALT Airway?

Post by DannusMaximus » Fri Oct 11, 2013 4:15 pm

Veritas wrote:Dannus: Dare I ask why you are using only Kings now?
The short answer is probably 'cost'... :wink:

My FD is a BLS agency only, even the paramedics on our rigs aren't allowed to intubate (unless the transport company medics are okay with them doing so). Accordingly, we are limited to basic oral and nasal airways. We also group purchase supplies with our transport agency (AMR) and they are the primary driver of what supplies we stock. They recently changed to Kings, so we followed along like baby ducks.

I wish I had a better answer for you, Veritas. Our admin people with lots of shiny stuff on their collars make those decisions for the grunts, and even as a Captain I'm still more an order follower than an order giver.
Holmes: "You have arms, I suppose?
Watson: "Yes, I thought it as well to take them."
Holmes: "Most certainly! Keep your revolver near you night and day, and never relax your precautions..."

- The Hound of the Baskervilles

User avatar
Veritas
* * * *
Posts: 942
Joined: Sun Sep 16, 2007 2:21 am

Re: SALT Airway?

Post by Veritas » Sat Oct 12, 2013 2:25 am

DannusMaximus wrote:
Veritas wrote:Dannus: Dare I ask why you are using only Kings now?
The short answer is probably 'cost'... :wink:

My FD is a BLS agency only, even the paramedics on our rigs aren't allowed to intubate (unless the transport company medics are okay with them doing so). Accordingly, we are limited to basic oral and nasal airways. We also group purchase supplies with our transport agency (AMR) and they are the primary driver of what supplies we stock. They recently changed to Kings, so we followed along like baby ducks.

I wish I had a better answer for you, Veritas. Our admin people with lots of shiny stuff on their collars make those decisions for the grunts, and even as a Captain I'm still more an order follower than an order giver.
Interesting. I know a bunch of medical directors, and they are all divided on the subject. It seems there is more empiric data on Combitubes compared to the King. But almost all the EMS guys I know prefer the King.

Jim: Nice. The McGrath was kinda cool, I played around with it a little. I prefer the GlideScope. I imagine that video laryngoscopy is going to be standard of care in hospital setting fairly soon. It will be interesting if the prehospital crowd follows suit. Aren't you mostly a prehospital guy? Do you do much fiberoptic?
Veritas liberabit vos

FAK | IFAK || BOB | GHB

User avatar
JIM
ZS Member
ZS Member
Posts: 1506
Joined: Sat Nov 10, 2007 8:30 am
Favorite Zombie Movies: Wall street (Dollar zombies FTL$)
Location: The Netherlands

Re: SALT Airway?

Post by JIM » Sat Oct 12, 2013 10:45 am

Veritas wrote:
DannusMaximus wrote:
Jim: Nice. The McGrath was kinda cool, I played around with it a little. I prefer the GlideScope. I imagine that video laryngoscopy is going to be standard of care in hospital setting fairly soon. It will be interesting if the prehospital crowd follows suit. Aren't you mostly a prehospital guy? Do you do much fiberoptic?
The glidescope is better in terms of teaching ( bigger screen, recording capabilities) but it has both a adult and pediatric blade while the mcgrath is adjustable.

Problem with the video laryngoscopy is that it does give a nice view of the vocal cords. But that's not nessesairely gonna get a tube through them, opposite to fibreoptic intubation.

Awake nasal fibreoptic intubation on a cooperative, spontaniously breathing patient is strategy #1 in a recognised difficult airway.

I don't think fibreoptic intubation will become a prehospital thing. Usually if intubation fails and bvm is inadequate, a (surgical) cricothyroidotomy combined with scoop&run seems more suitable to me.
Image

First-Aid primer and medical disclaimer

"Trust me, I'm a Medic. This won't hurt.... Me. You, I'm not so sure - probably a lot..''

IANMCDEVITT
* * * *
Posts: 835
Joined: Mon Oct 03, 2011 1:13 pm

Re: SALT Airway?

Post by IANMCDEVITT » Tue Oct 15, 2013 5:39 pm

Listen to JIM...........he's absolutely right.........and I'd throw that CombiTube in the trash before someone dies for a stupid reason.

okiebill
* *
Posts: 211
Joined: Wed Jan 04, 2012 8:52 pm

Re: SALT Airway?

Post by okiebill » Tue Oct 15, 2013 8:15 pm

I understand the use of the King over the Combi as the King is a EMT-B Airway Adjunct and the Combi is an Adanced / Paramedic Airway tool so it makes sense that departments would adopt the King airway exclusively.

Will it all become a moot point with products like "King Vision"?

I was led to believe during my EMT training that the Combi was not well loved at all ( Ive never used a combi but I was left with the impression that it was easier to make mistakes with it in high stress situations)

Ian, Is it just the Combi that you don't care for or do you include the King?

medic photog
* * *
Posts: 319
Joined: Wed Aug 08, 2012 10:47 pm
Location: PA
Contact:

Re: SALT Airway?

Post by medic photog » Tue Oct 15, 2013 10:26 pm

okiebill wrote:I understand the use of the King over the Combi as the King is a EMT-B Airway Adjunct and the Combi is an Adanced / Paramedic Airway tool so it makes sense that departments would adopt the King airway exclusively.

Will it all become a moot point with products like "King Vision"?

I was led to believe during my EMT training that the Combi was not well loved at all ( Ive never used a combi but I was left with the impression that it was easier to make mistakes with it in high stress situations)

Ian, Is it just the Combi that you don't care for or do you include the King?
The Combi-Tube is like trying to secure an airway with a hockey stick.

IANMCDEVITT
* * * *
Posts: 835
Joined: Mon Oct 03, 2011 1:13 pm

Re: SALT Airway?

Post by IANMCDEVITT » Wed Oct 16, 2013 12:20 pm

Can't stand the Combi......was always a shitty airway........aaaaaaa........look at it like closing one eye while shooting a short gun, OK, when you do that, you decrease your visual acuity 50%, so it's stupid to do, right?.................Now, the Combi is a double lumen airway. That gives you a 50/50 shot of screwing it up. I'd go with the king if your looking to indirectly ventilate the trachea (it's a single lumen airway). Not only that, the King comes in more sizes which increases your demographic..........see, a good medic can work on any patient at any age, that's one of the failings of some of our military programs...........specialization is for insects. Don't be just great at tubing adults with an ET tube. That really doesn't mean shit that you can tube adults.....great, good for you, you can tube adults!... what about the next call? It's a school bus rollover with ejection..........what are you going to do then? NOW THAT I'M ON A ROLL HERE.............another thing................don't friggin specialize with one type of laryngascope blade! JESUS GOD................don't tell me you specifically need a miller or a mac!............I'll kick you right in the nuts after I TUBE YOUR PATIENT!.........You should be able to do anything with anything!............HONESTLY............if you want a great airway kit? GET A POCKET MASK AND SOME NPA'S...................LEARN HOW TO USE IT................AND GET SOME SMALL OPA'S FOR THOSE PEDS............be a black belt with a pocket mask.........Gadgets suck.

IANMCDEVITT
* * * *
Posts: 835
Joined: Mon Oct 03, 2011 1:13 pm

Re: SALT Airway?

Post by IANMCDEVITT » Wed Oct 16, 2013 12:21 pm

Was I ranting?

okiebill
* *
Posts: 211
Joined: Wed Jan 04, 2012 8:52 pm

Re: SALT Airway?

Post by okiebill » Wed Oct 16, 2013 5:43 pm

IANMCDEVITT wrote:Was I ranting?
Naaaaa, not anymore then normal :wink:

User avatar
DannusMaximus
ZS Donor
ZS Donor
Posts: 2767
Joined: Wed Nov 19, 2008 9:00 pm
Location: Indiana's Southern Coast

Re: SALT Airway?

Post by DannusMaximus » Thu Oct 17, 2013 8:50 am

medic photog wrote:The Combi-Tube is like trying to secure an airway with a hockey stick.
IANMCDEVITT wrote:Can't stand the Combi......was always a shitty airway........aaaaaaa........look at it like closing one eye while shooting a short gun, OK, when you do that, you decrease your visual acuity 50%, so it's stupid to do, right?.................Now, the Combi is a double lumen airway. That gives you a 50/50 shot of screwing it up.
I'm genuinely surprised by the lack of love for the combitube. :ohdear:

I'm just a basic, so admittedly my options for airways are limited, but I've had good luck with combitubes over the years. It's been my experience that you end up in the esophagus about 99% of the time, which is fairly easy to determine by sticking a stethoscope on their tummy when you're attempting your first ventilations. Switch tubes if you hear gurgling, and bag away. We're still using our supply of combitubes at our station, when we run out and I start using the kings I might completely change my tune.

Did you guys always hate combitubes, or do they just suck in comparison to the tools you have available as you get more advanced training and credentials?
Holmes: "You have arms, I suppose?
Watson: "Yes, I thought it as well to take them."
Holmes: "Most certainly! Keep your revolver near you night and day, and never relax your precautions..."

- The Hound of the Baskervilles

IANMCDEVITT
* * * *
Posts: 835
Joined: Mon Oct 03, 2011 1:13 pm

Re: SALT Airway?

Post by IANMCDEVITT » Thu Oct 17, 2013 10:25 am

Always hated 'em.................if i had the choice, I'd use an NPA with a pocket mask and another medic holding cric pressure (OPA with pocket mask and neutral head position on Peds) .............and Dude, I used to use what was called an "EOA" and an "EGTA" so I earned my right to bash...................That's good Dan, that you have the environment to confirm, and the help on hand. It sounds like your confident with the adjunct and that's great, it fits your niche...... Now put yourself behind a mud wall at night in Afghanistan with a PKM hammering at guys near you and someone screaming into a radio sitting right next to you.....now add the fact that you've been out in the field, away from oversight and are not completely sure of your ability with said airway adjunct..............Diffrent story.

User avatar
DannusMaximus
ZS Donor
ZS Donor
Posts: 2767
Joined: Wed Nov 19, 2008 9:00 pm
Location: Indiana's Southern Coast

Re: SALT Airway?

Post by DannusMaximus » Thu Oct 17, 2013 2:53 pm

IANMCDEVITT wrote:Always hated 'em.................if i had the choice, I'd use an NPA with a pocket mask and another medic holding cric pressure (OPA with pocket mask and neutral head position on Peds) .............and Dude, I used to use what was called an "EOA" and an "EGTA" so I earned my right to bash...................That's good Dan, that you have the environment to confirm, and the help on hand. It sounds like your confident with the adjunct and that's great, it fits your niche...... Now put yourself behind a mud wall at night in Afghanistan with a PKM hammering at guys near you and someone screaming into a radio sitting right next to you.....now add the fact that you've been out in the field, away from oversight and are not completely sure of your ability with said airway adjunct..............Diffrent story.
Makes sense to me, Ian. There are substantial differences in operating environments, and a good tool for one might not be a good tool for another.
Holmes: "You have arms, I suppose?
Watson: "Yes, I thought it as well to take them."
Holmes: "Most certainly! Keep your revolver near you night and day, and never relax your precautions..."

- The Hound of the Baskervilles

IANMCDEVITT
* * * *
Posts: 835
Joined: Mon Oct 03, 2011 1:13 pm

Re: SALT Airway?

Post by IANMCDEVITT » Thu Oct 17, 2013 6:26 pm

Better said with less words! :rofl:

User avatar
SteelWolf
* * *
Posts: 362
Joined: Mon Nov 30, 2009 8:08 pm
Location: Tucson, AZ

Re: SALT Airway?

Post by SteelWolf » Fri Oct 18, 2013 4:01 pm

So much hate for blind insertion airways. I bet ya'll have the EZIO too.

Our cardiac arrest protocol now states EZIO and Combitubes (unless contraindicated). Why? You have vascular and airway access in like 30 seconds tops. And it works well.
TEMS / Flight Paramedic. NRP, FP-C, TP-C.
OIF / OEF Combat Veteran
Owner / Chief Instructor of Archangel Dynamics, LLC. Come visit us for all of your Medical Preparedness needs!
Do you live in or around Arizona? Come train with us! Firearms, Medical and Survival courses.
https://archangeldynamics.com/

IANMCDEVITT
* * * *
Posts: 835
Joined: Mon Oct 03, 2011 1:13 pm

Re: SALT Airway?

Post by IANMCDEVITT » Fri Oct 18, 2013 4:35 pm

At the Paramedic level? That adjunct is not the standard. It may work well for you but not the patient. Show me where that`s the acceptable standard at the Paramedic level. Show me how they out-perform the King?.......C`mon Brother, teach me.

User avatar
JIM
ZS Member
ZS Member
Posts: 1506
Joined: Sat Nov 10, 2007 8:30 am
Favorite Zombie Movies: Wall street (Dollar zombies FTL$)
Location: The Netherlands

Re: SALT Airway?

Post by JIM » Fri Oct 18, 2013 7:41 pm

Endotrachial intubation and Intravenous access are the golden standard.. If you're gonna take shortcuts (IO, LMA, compression only CPR) it better be patient-related and not because of lack of experience and/or training opportunities!
Image

First-Aid primer and medical disclaimer

"Trust me, I'm a Medic. This won't hurt.... Me. You, I'm not so sure - probably a lot..''

Post Reply

Return to “First Aid”