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Critical Care

Endotracheal intubation in the ICU is a high-risk procedure, resulting in significant morbidity and mortality. Up to 40% of cases are associated with marked hypoxemia or hypotension. The ICU patient is physiologically very different from the usual patient who undergoes intubation in the operating room, and different intubation techniques should be considered. The common operating room practice of sedation and neuromuscular blockade to facilitate intubation may carry significant risk in the ICU patient with a marked oxygenation abnormality, particularly when performed by the non-expert. Preoxygenation is largely ineffective in these patients and oxygen desaturation occurs rapidly on induction of anesthesia, limiting the time available to secure the airway. The ICU environment is less favorable for complex airway management than the operating room, given the frequent lack of availability of additional equipment or additional expert staff. ICU intubations are frequently carried out by trainees, with a lesser degree of airway experience. Even in the presence of a non-concerning airway assessment, these patients are optimally managed as a difficult airway, utilizing an awake approach. Endotracheal intubation may be achieved by awake direct laryngoscopy in the sick ICU patient whose level of consciousness may be reduced by sepsis, hypercapnia or hypoxemia. As the patient’s spontaneous respiratory efforts are not depressed by the administration of drugs, additional time is available to obtain equipment and expertise in the event of failure to secure the airway. ICU intubation complications should be tracked as part of the ICU quality improvement process.  
ccforum.com
about 4 years ago
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Awake Endotracheal Intubation - emdocs

An update on awake intubation with a discussion of the needed supplies, various techniques, complications, and modifications.  
emdocs.net
about 4 years ago
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Alternative intubation techniques vs Macintosh laryngoscopy in patients with cervical spine immobilization: systematic review and meta-analysis of randomized controlled trials

Interesting open access article from Switzerland! Alternative intubation techniques vs Macintosh laryngoscopy in patients with cervical spine immobilization: systematic review and meta-analysis of randomized controlled trials  
prehospitalmed.com
about 4 years ago
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Airway Management of the Critically Ill Patient: Modifications of Traditional Rapid Sequence Induction and Intubation

New FOAM journal , Critical Care Horizons! Check out open access article here! Airway Management of the Critically Ill Patient: Modifications of Traditional Rapid Sequence Induction and Intubation  
prehospitalmed.com
about 4 years ago
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NYC Airway course , 19-20th September 2015 – PLACES STILL LEFT, HURRY!

Register for one of the last 10 spots remaining on this excellent airway training course Directed by Dr Richard Levitan, an awesome faculty will teach you the cutting edge of emergency airway management Learn from the likes of Scott Weingart and George Kovacs! Brilliant talk from @emcrit: consider DSI to prevent peri-intubation arrest in hypoxic…  
prehospitalmed.com
about 4 years ago
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PHARM Podcast 118 : Life after SMACC

Hi Folks On today's show, I talk about life after SMACC, a way to remember John Hinds, prehospital airway/RSI and a paper from Victorian Ambulance. Show notes: SIGN THE PETITION FOR JOHN PLEASE! SEND TO ALL YOUR FRIENDS TOO! Paramedic rapid sequence intubation in patients with non-traumatic coma Now, onto the PODCAST! Right Click and…  
prehospitalmed.com
about 4 years ago
Sinaiem dark
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respiratory-failure

As we all know, NiPPV is a well established practice and therapy of choice in patients with COPD and CHF exacerbations.  It is typically used in patients with hypercarbic respiratory failure.  But for those patients who come to the ED with pure hypoxemic respiratory failure (in say, someone with pneumonia) is there a better way to oxygenate them when standard nasal cannula isn’t doing the trick and you want to avoid intubation?  According to 2 recent studies high flow nasal cannula may provide the answer.  In comparing NiPPV to standard oxygen delivery therapy to high flow nasal cannula the intubation rates did not differ significantly, but appear to be lower in the high flow NC group.  Additionally, the 90 day mortality rate was significantly lower and ventilator free days were increased in the the high flow NC group compared to the other two.  The other benefit is that there was less patient discomfort in the high flow NC group.  
sinaiem.org
about 4 years ago
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PHARM Podcast 119 with Ben Meadley MICA paramedic

@johnboy237 ably assisting with @AmbulanceVic HEMS. Thanks for visiting, hope you enjoyed the show! pic.twitter.com/XTNJ7KtL2a — Ben Meadley (@ben_meadley) October 9, 2014 Ben is the ugly one on the right Hi Folks On today's show, I talk to old friend of the show, Ben Meadley MICA Paramedic from Victoria. Show notes: Paramedic rapid sequence intubation…  
prehospitalmed.com
about 4 years ago
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To scan or not to scan - Part two: Answers and a summary of literature

If you recall from my previous post we were considering when to get a head CT on a pediatric patient with a closed head injury, and specifically how to approach this with the family. In general I find that its best to be honest and discuss the criteria outlined in the Kuppermann article (you know the one). It investigated risk of CT documented clinically important TBI (ciTBI) in children. A ciTBI is one that lead to death, neurosurgical intervention, stay in the hospital for >2 days and intubation for ≥24 hours. The population split between <2 and >2 years of age.  
pemcincinnati.com
about 4 years ago
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The Case of the Missing Awake Intubation Kit: Episode 2 - CanadiEM

In Episode 2 of hte Case of the Missing Awake Intubation kit, Jared Baylis reviews the potential items that should be included in such a kit.  
boringem.org
about 4 years ago
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Emergency Medicine Literature of Note: A Little Intubation Checklist Magic

Hello, You comment on their specific checklist, however I have not been able to actually find the checklist. Do you have a link to the checklist they use?  
emlitofnote.com
about 4 years ago
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Update: Analgesia and Sedation in the Intubated ED Patient - emdocs

Congrats on securing the airway! This article discusses strategies for post-intubation analgesia and sedation in the ED.  
emdocs.net
about 4 years ago
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Post Intubation Sedation for Pregnant Patients - R.E.B.E.L. EM - Emergency Medicine Blog

You have just intubated a seizing eclamptic woman who is 34 weeks pregnant what sedation medication would you use?  
rebelem.com
about 4 years ago
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The VAPORS and the Resuscitation Sequence of Intubation - Ri [...] | EMBlog Mayo Clinic

Last Friday July 31st we were fortunate to host Dr. Richard Levitan for his annual airway workshop, this year we experimented live stre…  
emblog.mayo.edu
about 4 years ago
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Paramedics Australasia International Conference 2015 featuring Dr Scott Weingart!

COME TO SURFING THE FOAM WORKSHOP where THE Dr Scott Weingart of EMCRIT fame will be presenting on Drinking the River (Why paramedics should know about FOAM and how to be excellent!) Brilliant talk from @emcrit: consider DSI to prevent peri-intubation arrest in hypoxic respiratory failure #smaccus pic.twitter.com/DvgrUdqRc9 — Ben C. Smith (@UltrasoundJelly) June 26,…  
prehospitalmed.com
about 4 years ago
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Plan B - from CCAM - Intensive Care Network

Check out the CCAM airway Plan B - all the equipment you need to know about, the essentials of fibre-optic intubation & a great video to demonstrate it all.  
intensivecarenetwork.com
about 4 years ago
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Successful Tracheal Intubation In Children With Difficult Airways: Seven Secret Techniques Every Anesthesiologist Should Know

Successful Tracheal Intubation In Children With Difficult Airways: 7 Secret Techniques https://t.co/6edgRfURli #anesthesianews— Anesthesiology News (@anesthesianews) August 20, 2015 //platform.twitter.com/widgets.js  
prehospitalmed.com
about 4 years ago
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New Research: Intubation vs Supraglottic Airway (SGA) Devices

New Research: Intubation vs Supraglottic Airway (SGA) Devices http://t.co/vduLdftK0m pic.twitter.com/Tx5x4hOwAp— MedicNerd (@MedicNerd_com) August 27, 2015 //platform.twitter.com/widgets.js  
prehospitalmed.com
almost 4 years ago