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The Crashing Patient Who Needs an Airway - Dr. Pearson

10/2/2014

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Picture
Predictors of poor outcome after intubation
  • shock index< 0.8
  • preintubation hypoxemia

Push Dose Pressors

   > epinephrine
        - onset 1 minute
        - duration 5-10 min
        - dose: 0.5-2 ml every 2-5 min(5-20 mcg)
        - code card epi and epi for anaphylaxis - both have 1 mg of epi, one is just more concentrated

   > phenylephrine
         - onset 1 min
         - duration 10-20 min
         - dose: 0.5-2 ml q2-5 minutes(50-200 mcg)


Optimizing Oxygenation Prior to Intubation

    > optimize positioning (Head of Bed at 20 degrees)
    > apneic preoxygenation & denitrogenation
    > continuous oxygenation delivered via high-low NC during the intubation


Intubation options
   > Awake
   > Rapid sequence intubation
   > Delayed sequence intubation - procedural sedation where the procedure is intubation 
          - ketamine 1-2 mg/kg > Preoxygenate > paralytic> intubation
          - caution with CAD, HTN, tachycardia
  > http://pedemmorsels.com/delayed-sequence-intubation/

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  • 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
    • Prospective Visiting Students
    • UNC/Wake Forest Students
    • 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