Airway Strategery

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).


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Mentioned in this episode

Rapid sequence awake intubation

Rapid Sequence Awake Intubation by EMCRIT

Use something like theĀ 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.

Pocket Bougie

Glidescope titanium

Jess Mason’s rapid sequence awake intubation narrative learning segment from EM:RAP

Books Scott and Rob are reading

When Breath Becomes Air

A Strange Relativity. Beautiful video done by Stanford University about When Breath Becomes Air author Pail Kalithini

Sapiens

Surrender New York

The War of Art

The Art of Learning

The Slow Regard of Silent Things

Strategery

Strategery

Comments

  1. Sid W

    Rob,
    Enjoyed this podcast. I am curious about your experience with Ketamine. From these two cases, it sounds like you did not have any problems slipping the scope in to get a look. Has that been your general experience with ketamine? Is the gag reflex pretty well suppressed with it? That’s been my concern with this strategy, is you make them gag, then they vomit, now things are really bad.
    -Sid W

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