Scott Weingart from EMCRIT guest stars in this episode to discuss his approach to two challenging airway cases. The common theme is ketamine and semi-awake intubation (or at least maintaining breathing while inserting the laryngoscope).
Mentioned in this episode
Rapid sequence awake intubation
Rapid Sequence Awake Intubation by EMCRIT
Use something like the EZ-Atomizer – Jet sprayer to administer lidocaine in rapid sequence awake intubation. About 12cc of 4% lidocaine jetted all around the back of the tongue, throat, direct the tip to the cords and epiglottis
2% or 5% topical lidocaine to the back of the tongue with a tongue depressor. It’ll slip down the back of the tongue into all the nooks and crannies
Cords not opening during an awake intubation? Try a small dose of propofol to relax the patient and abduct the cords.
Post intubation sedation. Be generous with analgesia and sedation. Rob prefers fentanyl bolus and drip, propofol bolus and drip. If a fentanyl drip isn’t readily available, Scott recommends using hydromorphone 1mg IV and then scheduled hypdromorphone in addition to propofol.
Jess Mason’s rapid sequence awake intubation narrative learning segment from EM:RAP
Books Scott and Rob are reading
A Strange Relativity. Beautiful video done by Stanford University about When Breath Becomes Air author Pail Kalithini