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Awake Intubation the EMCrit Way
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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.

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

Published in Health & Medicine
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Transcript

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