Awake Intubation the EMCrit Way

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Scott Weingart revisits his famous video, illustrating how awake intubation can be done efficiently and effectively, with the proper preparation.

Transcript of Awake Intubation the EMCrit Way

  • Awake Intuba tion
  • When is this a good idea?
  • Apneic RSI Awake Crash Tough YesNo Yes No
  • Apneic RSI Awake Crash Tough YesNo Yes No
  • Why is this a good idea?
  • Cases
  • Any predicted difficult airway that isnt 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!