Screencast: Advanced Airway Management for the Emergency Physician June 9th, 2010 by reuben in _lecture, airway high-def vimo screencast here. slideset here. audio here. Back Top Pulseless, Massive and Submassive PE: Role of lytics ACC/AHA Aortic Dissection Guideline Responses to “Screencast: Advanced Airway Management for the Emergency Physician” “pulling it out is more satisfying these days than putting it in.” – scott weingart here’s his extubation algorithm, pulled from http://blog.emcrit.org/podcasts/extubation/ Inclusion: – Resolution of clinical issue requiring intubation – Sp02 > 95% on FiO2 â‰¤40%, PEEP â‰¤5 cm H20 – RR < 30, SBP > 100, HR <130 - Patient not known to be a difficult intubation Preparation: - Turn off sedatives - Leave opioids on at a low dose (e.g. fentanyl 50 mcg/hr) - Allow patient to regain full mental status - If patient shows signs of discomfort, consider administering more pain medication - Patient should be able to understand and respond to commands Testing for readiness: - Ask patient to raise arm and leave in the air for 15 seconds - Ask patient to raise their head off the bed - Ask patient to cough, they should be able to generate a strong cough - Place patient on pressure support at a setting of 5 cm H20 and sit patient up to at least 45 degrees - Observe for 15-30 minutes, if SpO2 < 90%, HR > 140, SBP > 200, severe anxiety, or decreased LOC >> discontinue extubation attempt Procedure: – Have a nebulizer filled with normal saline attached to a mask – Sit patient up to at least 45 degrees – Suction ETT with bronchial suction catheter – Suction oropharynx with Yankauer suction – Deflate ET tube cuff – Have the patient cough, pull the tube during cough [[make sure pt is end-inhalation at the moment you pull tube — rjs]] – Suction oropharynx again – Encourage patient to keep coughing up secretions – Place nebulizer mask on patient at 4-6 liters per minute After extubation: – Patient should receive close monitoring for at least 60 minutes – If patient develops respiratory distress, NIV will often be sufficient to avoid reintubation reuben at 2010-11-19 02:36 Pingback:Airway – Advanced thinking | Sinai EM Media Site Leave a Reply Cancel replyYou must be logged in to post a comment.