Seconds from disaster – avoiding the airway clean kill

Posted byketaminhPosted inairway, Emergency anaesthesia, FOAMEd, Interviews of interesting people, Online critical airway training, Prehospital medicineTags:, , ,
Image from Twitter. No financial disclosures
Image from Twitter. No financial disclosures

Hi folks. The Airway Twitterati were asked a question about prehospital RSI and avoiding perintubation hypotension and arrest.

Here is my response and todays lesson!

Pre-reading first:

The overview of avoiding the haemodynamic airway clean kill by Scott Weingart

Then my SMACC 2013 talk here

AIRWAY CLEAN KILLS

Finally I found this great article on

AVOIDING CIRCULATORY COMPLICATIONS DURING ENDOTRACHEAL
INTUBATION AND INITIATION OF POSITIVE PRESSURE VENTILATION

Take home lessons!

  1. use ketamine at low dose 0.5mg/kg or lower
  2. give a larger dose of paralytic
  3. use epinephrine 10-25mcg bolus prior to giving induction/sedative
  4. Address Breathing and circulatory issues before dealing with Airway – decompress pneumothorax, pelvic binder, fluid bolus
  5. be gentle, titrate your IV anaesthesia. avoid the slam/bam/thankyou maam approach of RSI
  6. watch your post intubation ventilation volumes.

 

Post lesson further reading here:

Rapid sequence intubation of the shock patient/LITFL

Airway management in the Critically Ill/Vissers

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