Rapid Sequence Awake Intubation

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Nurses Edition Commentary

Mizuho Morrison, DO, Lisa Chavez, RN, and Kathy Garvin, RN
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Todd H. -

good morning...

great case...

Was the intubation done thru nasal fiberoptic or oral... if oral... was the patient supine??? if oral was a bite bloc used to prevent the teeth from clamping on the tube??

Jess Mason -

The Intubatuon was oral, sitting upright, no bite block.

Todd H. -

so essentialy, you loaded the 6.5 ETT with a fiberoptic scope...hooked the scope to the screen so you could do video fiberoptic... put the pre-loaded ETT witht he scope past the oropharnx into larynx..threaded fiberoptic past vocal cords and passed tube over scope???

wow

great job... Jessica that takes kahonas to do this on a colleague!!!
did you consider nasal...

Jess Mason -

Just to be clear, I did NOT do this intubation - just sharing the case because it is so unique with so many good learning points, I felt compelled to tell it on EMRAP. And yes, that is exactly how they did it.

Todd H. -

just curious

who did the intubation??? was it the ED team?? anesthesia???

it is still heroic work!!!!

Jess Mason -

I believe it was anesthesia, but I think ENT was there as well. Sounds like it was an all hands on deck situation.

ryan harris -

http://www.alcovemedical.com/ez-100g/

Link for ordering EZ sprayer from emcrit.org.

Ryan M -

Any thoughts to IV Lidocaine to blunt the wretching caused by the airway reflex?

Jess Mason -

Per Scott Weingart:

"Giving an IV anesthetic like lidocaine may sedate the patient and be counterproductive. Ondansetron may be a better choice if you really want to treat this, but I don't bother."

David L., M.D. -

This type of difficult airway (anatomy distorted at laryngeal inlet) may not allow tube passage. Any thoughts about emphasising the need to preparing for a surgical airway in this context?

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