CMC COMPENDIUM
  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • Alumni
  • STUDENTS/APPLICANTS
    • Medical Students at CMC
    • EM Acting Internship
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction

From Ordinary to Extraordinary - Dr. Pearson

4/27/2017

0 Comments

 
Picture
  • Post-Intubation Hypotension: 15% higher in-hospital mortality
    • Predictors:
      • Pre-intubation shock index (SI ≥ 0.8)*
      • Chronic renal disease
      • Intubation for acute respiratory failure
  • Push-dose (Bolus-Dose) Pressors:
    • Supportive bridge in selected patients:
      • Peri-intubation hypotension
      • Procedural sedation
      • Transporting long-distances from the ED
    • Push-dose Pressor Options
      • Phenylephrine in pre-mixed “STICK” (most common – be careful in brain injured or heart failure patients)
      • Epinephrine – will need to mix yourself
  • Pre-oxygenation: Rule of 15’s: Preoxygenation
    • Position: Head of bed                     @ > 15º
    • Non-rebreather mask                     @ 15 L / min
    • Nasal cannula                                    @ 15 L / min
    • CPAP / BVM + PEEP valve              @ 15 cm H2O
  • Delayed sequence intubation (DSI) Overview
    • “A procedural sedation, where the procedure is pre-oxygenation”
    • Basics: Delirious patient with hypoxia -> ketamine 1-2 mg/kg IV -> Preoxygenate (Preferably with CPAP/BiPAP)  ->  Wait 2 to 3 minutes ->  Administer paralytic -> Wait 45 to 60 seconds -> Intubate
  • DSI: Safe Apnea 
    • Safe Apnea = Duration of apnea until a patient reaches a saturation of 88-90%
    • Patients with increased metabolic demands and shunting desaturate faster.
  • DSI: Who might benefit from it? Patients with vital signs that are unobtainable, or unacceptable:
    • “Good Lungs, Bad Brains”: Agitated head injury / ETOH / Psych
    • Bad Lungs: Hypoxic  COPD, Pneumonia, ARDS
  • Apneic Oxygenation:
    • Alveoli continue to take up oxygen even without ventilation
    • Keep Nasal Cannula in place at 15 L/min during intubation attempt(s) to further prolong duration of safe apnea


    0 Comments

    Your comment will be posted after it is approved.


    Leave a Reply.

      Archives

      August 2018
      February 2018
      January 2018
      December 2017
      October 2017
      September 2017
      August 2017
      July 2017
      June 2017
      May 2017
      April 2017
      March 2017
      February 2017
      January 2017
      December 2016
      November 2016
      October 2016
      September 2016
      August 2016
      July 2016
      June 2016
      May 2016
      April 2016
      March 2016
      February 2016
      January 2016
      December 2015
      November 2015
      October 2015
      September 2015
      August 2015
      July 2015
      June 2015
      May 2015
      April 2015
      March 2015
      February 2015
      January 2015
      December 2014
      November 2014
      October 2014
      September 2014
      August 2014
      July 2014
      June 2014
      May 2014
      April 2014
      March 2014
      February 2014
      January 2014
      December 2013
      November 2013
      October 2013
      September 2013
      August 2013
      July 2013

      Categories

      All
      Abdominal Pain
      Abdominal-pain
      Airway
      Back Pain
      Back Pain
      Bleeding
      Change-in-mental-status
      Chest Pain
      Dizziness
      Ecg
      Emboli
      Environmental
      Fever
      Gyn
      Headache
      Hypertension
      Infectious Disease
      Pain
      Pediatric Emergency
      Professionalism
      Psych
      Respiratory Distress
      Sepsis
      Shock
      Toxins
      Trauma
      Vomiting
      Weakness

      RSS Feed

      Tweets by @PedEMMorsels
    Powered by Create your own unique website with customizable templates.
    • RESIDENCY
      • About CMC
      • Curriculum
      • Benefits
      • Explore Charlotte
      • Official Site
    • FELLOWSHIP
      • EMS
      • Global EM
      • Pediatric EM
      • Toxicology >
        • Tox Faculty
        • Tox Application
      • (All Others)
    • PEOPLE
      • Program Leadership
      • PGY-3
      • PGY-2
      • PGY-1
      • Alumni
    • STUDENTS/APPLICANTS
      • Medical Students at CMC
      • EM Acting Internship
      • Healthcare Disparities Externship
      • Resident Mentorship
    • #FOAMed
      • EM GuideWire
      • CMC Imaging Mastery
      • Pediatric EM Morsels
      • Blogs, etc. >
        • CMC ECG Masters
        • Core Concepts
        • Cardiology Blog
        • Dr. Patel's Coding Blog
        • Global Health Blog
        • Ortho Blog
        • Pediatric Emergency Medicine
        • Tox Blog
    • Chiefs Corner
      • Top 20
      • Current Chiefs
      • Schedules >
        • Conference/Flashpoint
        • Block Schedule
        • ED Shift Schedule
        • AEC Moonlighting
        • Journal Club/OBP/Audits Schedule
        • Simulation
      • Resources >
        • Fox Reference Library
        • FlashPoint
        • Airway Lecture
        • Student Resources
        • PGY - 1
        • PGY - 2
        • PGY - 3
        • Simulation Reading
        • Resident Wellness
        • Resident Research
        • Resume Builder
      • Individualized Interactive Instruction