MCHD Paramedic Podcast
“GCS <8; intubate” may be endangered, but not totally deserving of extinction
This episode of the MCHD Paramedic Podcast was inspired directly by a paramedic question: “In my prior service, we intubated much more often for airway protection, can you explain how you approach this in your practice?”
Whoa buddy, is that a difficult question with numerous caveats or what? Join the podcast crew as they attempt to better define airway patency versus airway protection. We even wade into why “GCS <8; intubate” may be endangered, but not totally deserving of extinction.
Listen to learn more about:
- Checking for a gag reflex: all risk and minimal reward?
- Patency over protection when it comes to urgency
- The 6 S’s to identify patency
- Resuscitate before we intubate
- Trauma considerations
- Watch the DELTA
- DSI is law of our land and intubation with paralysis is risky
Listen to next: Serial killers: Shortness of breath
- Duncan R et al. Decreased Glasgow Coma Scale score does not mandate endotracheal intubation in the emergency department. J Emerg Med. 2009. PMID: 19272743
- Lapostolle F, Alhéritière A. To intubate or not intubate, that is still the question! Eur J Emerg Med. 2020 Oct;27(5):387-388.
- Moulton C et al. Relation between Glasgow coma scale and the gag reflex. BMJ. 1991.
- Rotheray KR et al. What is the relationship between the Glasgow coma scale and airway protective reflexes in the Chinese population? Resuscitation, 2012.
- Spaite DW, Bobrow BJ, Keim SM, et al. Association of Statewide Implementation of the Prehospital Traumatic Brain Injury Treatment Guidelines With Patient Survival Following Traumatic Brain Injury: The Excellence in Prehospital Injury Care (EPIC) Study. JAMA Surg. 2019;154(7).
- Hedayati T, Aceves G. MGCS Less Than 8? Then Intubate! Emergency physicians monthly. https://epmonthly.com/article/gcs-less-than-8-then-intubate/
- Woods R. Basic Airway Assessment: It’s as easy as… 1-2-3? CanadiEM https://canadiem.org/basic-airway-assessment-easy-1-2-3/