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.

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Scott Weingart: Tubing the Shocked Patient

  1. 1. TheLaryngoscope as aMurder Weapon
  2. 2. How to stop killing ourfriggin’ patients whenintubating
  3. 3. Peri-IntubationDeaths arePreventable
  4. 4. HemodynamicsOxygenationLow pH
  5. 5. Hemodynamics
  6. 6. Case
  7. 7. 43 y/o MSepticPneumoniaSat 96%BP 62/40
  8. 8. Hypotension in thePeri-Intubationis RiskySchwartz et al. Anesthesiology 1995;82:367 andJ Crit Care 2012 Aug;27(4):417
  9. 9. PlanAhead
  10. 10. Meds
  11. 11. InductionAgent
  12. 12. Keep ‘em AliveNo MemoryNo PainNo Awareness
  13. 13. Keep ‘emAlive!No MemoryNo PainNo Awareness
  14. 14. All Sedatives will Drop BP inShock PatientsJ Clin Monit Comput 16(3): 183-190Anesth Analg 59(5): 355-358
  15. 15. I’mDying!
  16. 16. I’mChilling!
  17. 17. NegativetoPositivePressure
  18. 18. Cardiac stable doesn’t meanwhat you think it does
  19. 19. Propofol?
  20. 20. Etomidate
  21. 21. FlatHemodynamics
  22. 22. Dose
  23. 23. Midazolam+/-Fentanyl
  24. 24. Sympathetic Surge
  25. 25. Pain DosingMiddle GroundDissociation
  26. 26. Pain DosingMiddle GroundDissociation
  27. 27. HemodynamicMaintenance
  28. 28. Drug Delivery
  29. 29. Pain Control
  30. 30. emcrit.org/smacc
  31. 31. TBI/ICP?
  32. 32. Dose Induction based onplasma volume&clinical circumstances
  33. 33. Spare discomfort, Spoil life
  34. 34. RickDuttonsays…
  35. 35. Paralytics take longer towork
  36. 36. This sux isn’t working!&!!?
  37. 37. Ephedrine Placebo EsmololCardiac Output9.1 8 5.5Onset ofRocuronium 0.6mg/kg in sec 52 87 114ActaAnaesthesiol Scand 2003;47(9):1067
  38. 38. Sedatives LowParalytics High
  39. 39. What do I use?
  40. 40. PretreatmentwithScopolamine0.4 mg IVP
  41. 41. Ketamine0.25 - 0.5 mg/kg IVP
  42. 42. Sux 2 mg/kgorRoc 1.6 mg/kg
  43. 43. What to do during theperi-intubation
  44. 44. Fluids
  45. 45. Shoot for a high BPBEFOREIntubating
  46. 46. InoPressors
  47. 47. Bolus Dose InoPressor
  48. 48. PhenylephrineEpinephrine
  49. 49. PhenylephrineEpinephrine
  50. 50. Vent Settings
  51. 51. Low & Slow
  52. 52. DSI
  53. 53. Hemodynamic
  54. 54. To Review…
  55. 55. Plan AheadDose SmartPEEP is not always thesolution
  56. 56. Plan AheadDose Smartdd
  57. 57. Plan AheadDose SmartRespond Aggressively
  58. 58. MostVulnerable Moment
  59. 59. TheLaryngoscope as aMurder Weapon

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