Tag: intubation

ECMO for Severe ARDS

Mr. Jackson is a 36-year-old man whom you are caring for in the intensive care unit (ICU). Before this hospitalization, he was healthy and took no medications. He has never smoked, and he drinks three or four beers every... read more

Acute Salicylate Toxicity, Mechanical Ventilation, and Hemodialysis

In patients requiring intubation from acute salicylate toxicity, hemodialysis should be considered as part of management, as this is associated with decreased mortality. Salicylates are common substances that can be purchased... read more

Oxygenate, Ventilate, Do No Harm

Emergency physicians (EPs) are experts in emergent airway management and thus must be confident managing mechanical ventilation. Hospital-wide bed shortages mean that EPs will be managing admitted patients for longer periods... read more

Critical Hemoglobin Desaturation Will Occur before Return to an Unparalyzed State following 1 mg/kg Intravenous Succinylcholine

The American Society of Anesthesiologists (ASA) difficult airway algorithm recommends that if initial attempts at tracheal intubation after the induction of general anesthesia are unsuccessful, the practitioner should "consider... read more

Thai cave rescue: The drug that allowed boys to survive rescue mission

Thai schoolboys were rescued from the cave using dissociative ketamine plus positive-pressure facemask ventilation (to prevent water from leaking into their masks), so they basically used delayed sequence intubation strategy.... read more

Noninvasive Ventilation in Patients With ARF and Do-Not-Intubate and Comfort-Measures-Only Orders

A large proportion of patients with do-not-intubate orders who received noninvasive ventilation survived to hospital discharge and at 1 year, with limited data showing no decrease in quality of life in survivors. Provision... read more

Trach Travails: Need-to-Know ED Tricks for Airway Emergencies in Tracheostomy Patients

The outside hospital emergency physician passed a bougie through the patient’s existing metal trach and exchanged the metal trach for a 6-0 endotracheal tube. After the exchange, the ETT cuff was inflated, and the patient... read more

Guidelines for the Management of Tracheal Intubation in Critically Ill Adults

These guidelines describe a comprehensive strategy to optimize oxygenation, airway management, and tracheal intubation in critically ill patients, in all hospital locations. They are a direct response to the 4th National... read more

Acute Skeletal Muscle Wasting in Critical Illness

Among these critically ill patients, muscle wasting occurred early and rapidly during the first week of critical illness and was more severe among those with multiorgan failure compared with single organ failure. These findings... read more

Rapid Sequence Intubation With Video Laryngoscopy Common for Difficult Airways

Predicted difficult airways in one emergency department are managed most often using rapid sequence intubation (RSI) and video laryngoscopy (VL), a recent study has found. Although difficult airways occur frequently in emergency... read more

Tracheal extubation with a predicted difficult airway

Management of the difficult airway is an important, but as yet poorly-studied, component of intensive care management. Although there has been a strong emphasis on prediction and intubation of the difficult airway, safe extubation... read more

Sevoflurane for the treatment of refractory status epilepticus in the critical care unit

A 50-year-old woman with liver failure was admitted to critical care for refractory status epilepticus (RSE). Following tracheal intubation, sevoflurane was administered via the MIRUS system (Pall Medical, Dreieich, Germany).... read more

Intubation in Special Patient Populations: Intracranial Hemorrhage

Lidocaine has weak evidence to support its ICP blunting effects. Fentanyl may be a better choice. Ketamine is a reasonable alternative to etomidate during induction. No differnce in mortality exists between usage of succinylcholine... read more

Lighter Emergency Breathing Tubes Associated with Higher Survival After OHCA

In the LT group, 18.3% of patients survived 72 hours in the hospital, compared to 15.4% in the intubation group. From the LT group, 10.8% survived to hospital discharge, and only 8.1% in the intubation group. The proportion... read more

A Nightmare Airway with Rob Bryant

In terms of airway management, cricothyrotomy is one of the most advanced airway procedures an ED physician will perform. It is a last resort procedure when a patient is not able to be ventilated/oxygenated and/or intubated.... read more

Looking for a Better Way to Treat Hypoxia in the Emergency Department? Reach for High-Flow Nasal Cannula

High-flow nasal cannula should be considered a first-line therapy in all patients with hypoxemic respiratory failure not from cardiogenic pulmonary edema and without concomitant hypercapnia. The high flow rate of HFNC offers... read more

Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients With Difficult Airways Undergoing Emergency Intubation

In this emergency department, use of a bougie compared with an endotracheal tube + stylet resulted in significantly higher first-attempt intubation success among patients undergoing emergency endotracheal intubation.... read more

Resuscitation Sequence Intubation – Hypoxemia Kills

This blog post is the second part of a series of 3, on a recent lecture I was asked to give on Critical Care Updates: Resuscitation Sequence Intubation. This talk was mostly derived from a podcast by Scott Weingart (Twitter:... read more

Airway Management Techniques during Massive Regurgitation, Emesis, or Bleeding

Friend to the show, Jim DuCanto has been obsessed with SALAD. Not the leafy greens delicately touched with a tart emulsion, but with Suction Assisted Laryngoscopy and Airway Decontamination (SALAD). Jim DuCanto, MD is an... read more

The A1 Sedation Package: Better Care for Intubated Patients

You are called to the scene of a 56-year-old male found unresponsive in his garage workshop. Upon examining him you find him minimally responsive to painful stimulus, moaning and groaning. His family tells you he has high... read more

Pre-hospital advanced airway management by anaesthetist and nurse anaesthetist critical care teams

When performed by experienced physician anaesthetists and nurse anaesthetists, pre-hospital tracheal intubation was completed rapidly with high success rates and a low incidence of complications. The critical care teams attended... read more

Techniques for the Difficult Airway

A systematic approach to intubation that emphasizes planning and teamwork can reduce intubation complications. Early use of an EGA or cricothyroidotomy may reduce complications when oxygenation is inadequate. Use of a gum... read more