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.

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Awake Intubation the EMCrit Way

  1. 1. Awake Intuba tion
  2. 2. When is this a good idea?
  3. 3. Apneic RSI Awake Crash Tough YesNo Yes No
  4. 4. Apneic RSI Awake Crash Tough YesNo Yes No
  5. 5. Why is this a good idea?
  6. 6. Cases
  7. 7. Any predicted difficult airway that isn’t crash
  8. 8. Awake Intubation
  9. 9. Dry ‘em out Topicalize Sedate Ready the Patient Intubate
  10. 10. Dry ‘em out Topicalize Sedate Ready the Patient Intubate
  11. 11. Dry ‘em out Topicalize Sedate Ready the Patient Intubate
  12. 12. Dry ‘em out Topicalize Sedate Ready the Patient Intubate
  13. 13. Dry ‘em out Topicalize Sedate Ready the Patient Intubate
  14. 14. Dry ‘em Out
  15. 15. Antisialagogue (Choose 1) · Glycopyrolate 0.2-0.4 mg IV Atropine 0.5-1 mg IV ·
  16. 16. Dry ‘em Out
  17. 17. Suction and Pad Dry
  18. 18. My Residents
  19. 19. Topicalize
  20. 20. 5 ml of 4% Lidocaine nebulized @ 5 LPM
  21. 21. My resident, Raghu, was teased for months for that last suctioning Sorry, Raghu!
  22. 22. Spray the back of the oropharynx if necessary
  23. 23. I should have smurfed the methylene blue!
  24. 24. Mucosal Atomization Device
  25. 25. Lido Lollipop
  26. 26. Consider anesthetizing below the cords
  27. 27. TransTracheal Injection (optional) 3cc of 4% Lidocaine
  28. 28. MAD Below Cords (optional) 3cc of 4% Lidocaine
  29. 29. Be aware of anesthesia toxicity
  30. 30. Sedate
  31. 31. Versed 2 mg
  32. 32. Dexmedetomidine
  33. 33. Remifentanil
  34. 34. Ketamine Alone (10 mg Aliquots)
  35. 35. Ketofol 75% Ketamine and 25% Propofol in a syringe (15/5 cc of each)
  36. 36. Preoxygenate
  37. 37. Nasal Cannula
  38. 38. Optimally Position the Patient
  39. 39. Optimally Position the Patient R. Levitan
  40. 40. Restrain the Patient
  41. 41. Switch to just the Nasal Cannula
  42. 42. 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
  43. 43. Extra Meds with someone to push them
  44. 44. Intubate
  45. 45. Minimize Touching
  46. 46. 1. Fiberoptic Bronch 2. Fiberoptic Stylet 3. Video Laryngoscope 4. Standard Laryngoscope
  47. 47. 2. Fiberoptic Stylet
  48. 48. 1. Fiberoptic Bronch 2. Fiberoptic Stylet 3. Video Laryngoscope 4. Standard Laryngoscope
  49. 49. 1. Fiberoptic Bronch 2. Fiberoptic Stylet 3. Video Laryngoscope 4. Standard Laryngoscope
  50. 50. 1. Fiberoptic Bronch 2. Fiberoptic Stylet 3. Video Laryngoscope 4. Standard Laryngoscope
  51. 51. Rudy Malmquist
  52. 52. Have a Backup Plan and a Failure Plan
  53. 53. Backup Plan
  54. 54. Retrograde Intubation
  55. 55. Failure Plan
  56. 56. RSI LMA Cric
  57. 57. Post-Tube Care
  58. 58. To Review
  59. 59. Dry ‘em out Topicalize Sedate Ready the Patient Intubate
  60. 60. Dry ‘em out Topicalize Sedate Ready the Patient Intubate
  61. 61. Dry ‘em out Topicalize Sedate Ready the Patient Intubate
  62. 62. Dry ‘em out Topicalize Sedate Ready the Patient Intubate
  63. 63. Dry ‘em out Topicalize Sedate Ready the Patient Intubate
  64. 64. AWAKE INTUBATION LEAVES YOU IN CONTROL!

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