Module B: Hour 2

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Module B Hour 2

• Intubation Difficulties

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Think ahead !!!!

• If you suspect a difficult airway call for help
  early
• What increases
• the risk of a
• difficult airway ?

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Mallampati

• Is Mallampati a famous curry dish from the south
  of India ?

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The 6 Ps of RSI

• Preparation (5 min)
• Pre-oxygenation (2 min)
• Paralysis / induction
• Protection and positioning (30 seconds)
• Placement (45 seconds)
• Post-intubation care

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P1 Preparation

• What preparations do you make before intubating ?
• What is Soap Me ?

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P2 Preoxygenate

• What are the physiological aims of
  pre-oxygenation ?
• How are these achieved ?

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P3 Paralysis/Induction

• What problems arise with the common induction
  agents ?
• Compare the use of these
• Suxamethonium vs Rocuronium

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P4 Protection/Positioning

• How do you achieve in-line stabilisation if
  necessary ?

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P5 Placement

• How do you confirm your tube placement ?

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P6 Post-intubation care

• Sedation
• Paralysis
• Monitoring
• Humidification
• NG tube and IDC

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Mrs AO, 72 years old

• BIBA from GPs waiting room
• Sudden stridor given adrenaline/ventolin/
• phenergan/lasix at GPs for ? anaphylaxis ? APO
• Sats 95 on R/A on arrival, fairly comfortable.
• Intermittently complains of SOB, audible soft
  stridor, two word sentences. Epigastric pain.
• What is your management ?

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Describe the X-ray
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The patient needs a CT chest.

• How would you proceed ?

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Mr DI, 73 years old

• GCS 7, found on floor by wife (E1 V1 M5)
• Increased tone /reflexes on right
• PEARL, but small
• PMHx IHD , A/F on warfarin
• Gurgling respirations
• Sats 89 on R/A, RR 16/min
• What is your management ?

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You are unable to intubate this is your view.

• What grade of laryngoscopy is this ?

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Laryngoscopy

• What would you do next ?

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Second look

• STOP, re-oxygenate, rethink
• BURP
• Introducer
• BOUGIE (if you can see the epiglottis)
• Different blade

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You remain unable to intubate.

• What would you do next ?

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End of the line

• What do you do if you cant intubate and you
  cant ventilate a patient ?

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Reminder

• Nobody ever died from a failure to intubate.
• They died from a failure to ventilate.

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Discussion