The Crashing Patient Who Needs an Airway - Dr. Pearson

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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