Awake Intuba

tion

When is this a good idea?

Apneic

RSI Awake

Crash

Tough

Yes No

Yes

No

Apneic

RSI Awake

Crash

Tough

Yes No

Yes

No

Why is this a good idea?

Cases

Any predicted difficult airway that isn’t crash

Awake Intubation

Dry ‘em out

Topicalize

Sedate

Ready the Patient

Intubate

Dry ‘em out

Topicalize

Sedate

Ready the Patient

Intubate

Dry ‘em out

Topicalize

Sedate

Ready the Patient

Intubate

Dry ‘em out

Topicalize

Sedate

Ready the Patient

Intubate

Dry ‘em out

Topicalize

Sedate

Ready the Patient

Intubate

Dry ‘em Out

Antisialagogue (Choose 1)

· Glycopyrolate 0.2-0.4 mg IV

Atropine 0.5-1 mg IV ·

Dry ‘em Out

Suction and Pad Dry

My Residents

Topicalize

5 ml of 4% Lidocaine nebulized @ 5 LPM

My resident, Raghu, was teased for months for

that last suctioning

Sorry, Raghu!

Spray the back of the oropharynx if necessary

I should have

smurfed the

methylene

blue!

Mucosal Atomization Device

Lido Lollipop

Consider anesthetizing below the cords

TransTracheal Injection

(optional)

3cc of 4% Lidocaine

MAD Below Cords (optional)

3cc of 4% Lidocaine

Be aware of anesthesia toxicity

Sedate

Versed 2 mg

Dexmedetomidine

Remifentanil

Ketamine Alone (10 mg Aliquots)

Ketofol 75% Ketamine and 25% Propofol in a syringe (15/5 cc of

each)

Preoxygenate

Nasal Cannula

Optimally Position the Patient

Optimally Position the Patient

R. Levitan

Restrain the

Patient

Switch to just the

Nasal Cannula

Equipment check

Fiberoptic Laryngoscope/Stylet Bougie

8-0 Tube 7-0 Tube

Extra Ketofol LMA

Cric Set-up Paralytic

Syringe with MAD with 4% Suction/BVM/ETCO2

Extra Meds with someone to push them

Intubate

Minimize Touching

1. Fiberoptic Bronch 2. Fiberoptic Stylet 3. Video Laryngoscope 4. Standard Laryngoscope

2. Fiberoptic Stylet

1. Fiberoptic Bronch 2. Fiberoptic Stylet 3. Video Laryngoscope 4. Standard Laryngoscope

1. Fiberoptic Bronch 2. Fiberoptic Stylet 3. Video Laryngoscope 4. Standard Laryngoscope

1. Fiberoptic Bronch 2. Fiberoptic Stylet 3. Video Laryngoscope 4. Standard Laryngoscope

Rudy Malmquist

Have a Backup Plan

and a Failure Plan

Backup Plan

Retrograde Intubation

Failure Plan

RSI LMA Cric

Post-Tube Care

To Review

Dry ‘em out

Topicalize

Sedate

Ready the Patient

Intubate

Dry ‘em out

Topicalize

Sedate

Ready the Patient

Intubate

Dry ‘em out

Topicalize

Sedate

Ready the Patient

Intubate

Dry ‘em out

Topicalize

Sedate

Ready the Patient

Intubate

Dry ‘em out

Topicalize

Sedate

Ready the Patient

Intubate

AWAKE INTUBATION LEAVES YOU IN CONTROL!