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Rapid intubation

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Rapid intubation

  1. 1. Rapid IntubationErica CorraoOct. 19, 2012Health Education for Allied HealthYoungstown State University
  2. 2. What is Rapid Intubation● The cornerstone for emergency airway management● Results in rapid unconsciousness and paralysis in a patient● Considered a “crash” airway
  3. 3. Indications● Inability to maintain airway patency● Inability to protect the airway against aspiration● Ventilatory compromise● Failure to adequately oxygenate pulmonary capillary blood● Anticipation of a deteriorating course that will eventually lead to the inability to maintain airway patency or protection
  4. 4. Goal● To intubate the trachea without having to use bag-valve-mask ventilation● Without using sedative agents alone● Administration of weight-based doses of an induction agent immediately followed by a paralytic agent to get the patient unconscious within 1 minute
  5. 5. Contraindications● Absolute- total upper airway obstruction & total loss of facial/oropharyngeal landmarks● Relative- anticipated difficult airway to achieve● “Crash” airway- when the patient is in an arrest situation, unconscious and apneic
  6. 6. Anesthesia● 3 phases of medication administration● Pretreatment, induction, and paralysis
  7. 7. Preoxygenation● Preoxygenation with nonrebreather mask for 5 minutes prior● Allows the patient to maintain blood oxygen saturations during the apneic period of paralysis and allow for more time to intubate
  8. 8. Pretreatment● Used to help the response to larygnoscopy and induction and paralysis● Typically administered 2-3 minutes prior to induction and paralysis● Examples are LOAD (lidocaine, opioid analgesic, atropine, defasciculating agents
  9. 9. Induction● Provide rapid loss of consciousness that helps ease the intubation and avoids psychic harm to the patient● Examples of meds are: Etomidate, Ketamine, Propofol & Midazolam
  10. 10. Paralysis● Need to be administered immediately after the induction agent● Neuromuscular blockade does not provide sedation so administering a right dose of the induction agent is important
  11. 11. Equipment Needed● Laryngoscope● Endotracheal tube● Stylet● 10 mL syringe● Suction Catheter● CO2 detector● Oral and Nasal airway● Ambu bag and mask
  12. 12. Positioning● Place patient in sniffing position for adequate visualization. You will need to flex the neck and extend the head● This position helps with visualization of the glottic opening
  13. 13. Technique● Preparation – Confirm that equipment is functional – Assess for difficult airway – Establish Intravenous access – Draw up drug and determine sequence – Review contraindications to meds – Attach monitoring equipment – Check endotracheal tube for leak – Ensure function light bulb on laryngoscope blade
  14. 14. Technique● Preoxygenation – Administer 100% oxygen through nonrebreather mask for 5 minutes for nitrogen washout – Assist ventilation with bag-valve-mask system only if needed to keep oxygen saturations greater than or equal to 90%
  15. 15. Technique● Pretreatment – See Anesthesia slide for more information – Consider administration of drugs to mitigate the adverse effects of intubation
  16. 16. Technique● Induction of Paralysis – Give a rapid acting induction medication to produce loss of consciousness – Administer neuromuscular blocking agent immediately after the induction agent – Should be given by intravenous push
  17. 17. Technique● Protection and Positioning – Provide cricoid cartilage pressure – Maintain pressure until ETT is verified in position
  18. 18. Technique● Placement with Proof – Visualize the ET tube passing through vocal cords – Confirm tube placement with a color change by CO2 dector and auscultation
  19. 19. Technique● Postintubation Management – Secure ET tube in place – Initiate mechanical ventilator – Obtain chest x-ray – Administer proper meds for patient comfort and other factors
  20. 20. Complications● Esophageal intubation● Iatrogenic induction of an obstructive airway● Right mainstem intubation● Pneumothorax● Dental trauma● Postintubation pneumonia
  21. 21. Complications● Vocal cord avulsion● Failure to intubate● Hypotension● Aspiration
  22. 22. Conclusion● Rapid Sequence Intubation (RSI) is the preferred technique in emergency departments.● It is not indicated in a patient who is unconscious and apneic.● Approach with caution in a difficult airway● Proper technique is key
  23. 23. Reference● Rapid Sequence Intubation – Medscape Reference –