How not to kill your hypoxic patient.
Key Points:
- Pre-Oxygenate with CPAP/BVM+PEEP
- Sit up
- Use Ap-Ox
- Roc rocks
- 1st pass success is critical
- Ventilate during apnoea
Show Notes:
Pre-oxygenation
Preoxygenation, Reoxygenation and Deoxygenation – EMCrit
Covers Pre-oxygenation with CPAP in the hypoxic patient – watch the 2 videos
Preoxygenation and Prevention of Desaturation During Emergency Airway Management article by Scott Weingart and Rich Levitan – a must read
RebelEM – a nice summary and explanation of the above paper
http://lifeinthefastlane.com/ccc/preoxygenation/ – LITFL’s overview
The problem with the BVM for pre-oxygenation – Nick Crimes
Positioning
Levitan’s ear-to-sternal notch positioning
Find out about ramping here and here (EMUpdates)
See also the PreOx, ReOx paper by Weingart & Levitan
Apnoeic oxygenation
NO DESAT! – Rich Levitan
PulmCrit – an in-depth discussion by Josh Farkas, including the THRIVE study
http://lifeinthefastlane.com/ccc/apnoeic-oxygenation/ – LITFL’s overview
Apnoeic oxygen relies on an open airway, so we have to maintain a jaw thrust.
NCs buy you more time, in normal, obese and hypoxic patients.
High-flow NC would be even better, but are complicated because getting a BVM seal over them is not possible
DSI – Delayed Sequence Intubation
The Website – EMCrit
The Paper – no longer FOAM, but you can find it here
http://lifeinthefastlane.com/ccc/delayed-sequence-intubation/ – LITFL’s comprehensive overview
Rocuronium vs Suxamethonium
Video from Reuben Strayer from EMUpdates
Apnoeic Ventilation
Video from EMCrit
See also the PreOx, ReOx paper by Weingart & Levitan
Recent paper on using the Hamilton Ventilator for this (VAPOX)
1st Pass Intubation
The importance of 1st pass success, by Cliff Reid, and how to do it, by LITFL
Awake Intubation
Airway topicalisation and awake intubation, by EMCrit, and KSI here and here, by EMUpdates
Thanks,
Stacy