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Scott Weingart: Tubing the Shocked Patient
 

Scott Weingart: Tubing the Shocked Patient

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The lowdown on getting your priorities straight and your doses optimised when tubing a shocked patient.

The lowdown on getting your priorities straight and your doses optimised when tubing a shocked patient.

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    Scott Weingart: Tubing the Shocked Patient Scott Weingart: Tubing the Shocked Patient Presentation Transcript

    • TheLaryngoscope as aMurder Weapon
    • How to stop killing ourfriggin’ patients whenintubating
    • Peri-IntubationDeaths arePreventable
    • HemodynamicsOxygenationLow pH
    • Hemodynamics
    • Case
    • 43 y/o MSepticPneumoniaSat 96%BP 62/40
    • Hypotension in thePeri-Intubationis RiskySchwartz et al. Anesthesiology 1995;82:367 andJ Crit Care 2012 Aug;27(4):417
    • PlanAhead
    • Meds
    • InductionAgent
    • Keep ‘em AliveNo MemoryNo PainNo Awareness
    • Keep ‘emAlive!No MemoryNo PainNo Awareness
    • All Sedatives will Drop BP inShock PatientsJ Clin Monit Comput 16(3): 183-190Anesth Analg 59(5): 355-358
    • I’mDying!
    • I’mChilling!
    • NegativetoPositivePressure
    • Cardiac stable doesn’t meanwhat you think it does
    • Propofol?
    • Etomidate
    • FlatHemodynamics
    • Dose
    • Midazolam+/-Fentanyl
    • Sympathetic Surge
    • Pain DosingMiddle GroundDissociation
    • Pain DosingMiddle GroundDissociation
    • HemodynamicMaintenance
    • Drug Delivery
    • Pain Control
    • emcrit.org/smacc
    • TBI/ICP?
    • Dose Induction based onplasma volume&clinical circumstances
    • Spare discomfort, Spoil life
    • RickDuttonsays…
    • Paralytics take longer towork
    • This sux isn’t working!&!!?
    • Ephedrine Placebo EsmololCardiac Output9.1 8 5.5Onset ofRocuronium 0.6mg/kg in sec 52 87 114ActaAnaesthesiol Scand 2003;47(9):1067
    • Sedatives LowParalytics High
    • What do I use?
    • PretreatmentwithScopolamine0.4 mg IVP
    • Ketamine0.25 - 0.5 mg/kg IVP
    • Sux 2 mg/kgorRoc 1.6 mg/kg
    • What to do during theperi-intubation
    • Fluids
    • Shoot for a high BPBEFOREIntubating
    • InoPressors
    • Bolus Dose InoPressor
    • PhenylephrineEpinephrine
    • PhenylephrineEpinephrine
    • Vent Settings
    • Low & Slow
    • DSI
    • Hemodynamic
    • To Review…
    • Plan AheadDose SmartPEEP is not always thesolution
    • Plan AheadDose Smartdd
    • Plan AheadDose SmartRespond Aggressively
    • MostVulnerable Moment
    • TheLaryngoscope as aMurder Weapon