Start with a free trial account for free content every month. Already a subscriber? Sign in.

Critical Care Mailbag – Case of the Slow Crash

Kevin Jones, DO, Rob Orman, MD, and Scott Weingart, MD
00:00
21:56
Sign in or subscribe to listen

No me gusta!

The flash player was unable to start. If you have a flash blocker then try unblocking the flash content - it should be visible below.

Nurses Edition Commentary

Lisa Chavez, RN and Kathy Garvin, RN
00:00
02:42

No me gusta!

The flash player was unable to start. If you have a flash blocker then try unblocking the flash content - it should be visible below.

EM:RAP 2017 March Written Summary 580 KB - PDF

A patient you recently intubated becomes hypoxic and difficult to bag. What’s going on? The DOPES mnemonic is a good first step to troubleshoot.

To view chapter written summaries, you need to subscribe.

Sign up today for full access to all episodes.

Marlene G. -

Ok. I work in the same circumstance as the doc in this episode, minus the hospitality or anesthesiologist. I need some more guidance as to timing of intubation, please.

Rob O -

Hey Marlene, this is a matter of great debate (as illustrated by the different phiosophies Scott and I posited in the segment). When posing this question to a large group of ED docs, the inflection point of when to go from observation to intervention varied widely. Most I've spoken with intervene when there are findings or symptoms of airway involvement. This is more gestalt than something that can be clearly measured. Some docs who work in urban areas with a high frequency of angioedema patients feel more comfortable with watching and waiting even with some degree of airway involvement, such as minor to moderate tongue swelling. Most, however, are more proactive and intubate when there is even a sense of progressive airway swelling. I am going to pose this question to the twitterverse and we'll get some more opinions. I wish there were a hard and fast answer

Donald Z., M.D. -

From what i heard i wound not have intubated this patient. I have seen many and i wait until they have some laryngeal signs/symptoms. I would definitely have marked the neck (for cric) and put them on close observation. I would have tried some epinephrine too(cant recall if this was done).

David G., M.D. -

I can't see how isolated lip swelling requires airway management. Open your mouth and breath, or breath through your nose.

To join the conversation, you need to subscribe.

Sign up today for full access to all episodes and to join the conversation.

To download files, you need to subscribe.

Sign up today for full access to all episodes.
Crashing Slowly Full episode audio for MD edition 238:10 min - 332 MB - M4AEM:RAP 2017 March German Edition Deutsche 73:21 min - 101 MB - MP3EM:RAP 2017 March Spanish Edition Español 89:05 min - 122 MB - MP3EM:RAP 2017 March Aussie Edition Australian 16:33 min - 23 MB - MP3EM:RAP 2017 March French Edition Français 25:15 min - 35 MB - MP3EM:RAP 2017 March Canadian Edition Canadian 28:50 min - 40 MB - MP3EM:RAP 2017 March Board Review Answers 262 KB - PDFEM:RAP 2017 March Board Review Questions 218 KB - PDFEM:RAP 2017 March MP3 Files 316 MB - ZIPEM:RAP 2017 March Written Summary 580 KB - PDF

To earn CME for this chapter, you need to subscribe.

Sign up today for full access to all episodes and earn CME.

6 AMA PRA Category 1 Credits™ certified by CEME (EM:RAP)

  1. Complete Quiz
  2. Complete Evaluation
  3. Print Certificate