Posts Tagged awake intubation

Who is this awake intubation stuff for anyway?

So after the awake intubation video went up on emrap tv, I got a flurry of emails telling me how cool the concept is, but questioning who this would actually be usable on.

To answer that question, we first must discuss who actually requires intubation. If you wait until the patient is apneic, then of course you can’t use awake intubation. The idea is to intubate before the patient stops breathing. If you predict a patient is a difficult airway, you can and should perform the intubation awake.

In EMCrit Podcast 23, I discuss who actually requires intubation and which of these patients can be done awake.

I also discuss a new indication for awake intubation: the hypotensive trauma patient.

[click here to read more and hear the podcast]

photo by pig sty ave

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The Awake Intubation Video

Awake intubation can save your butt!

In EMCrit Podcast 18, we discuss RSI’s less popular sibling: awake intubation. It requires forethought and humility–you must be able to say to yourself, “I am not sure I will be able to successfully intubate this patient.” However, the payoff for this thought process is enormous. You can attempt an intubation on a difficult airway with very few downsides. If you get it, you look like a star, if you don’t you have not made the situation worse.

It all comes down to what is best for our patients. If the airway is predicted to be difficult and you perform RSI or even worse, a sedation-only intubation and you fail, then the morbidity/mortality that ensues was preventable.

Two of my critical care resident specialists, Raghu Seethala and Xun Zhong, volunteered to intubate each other awake. The purpose of this was to let them gain experience, understand what their patients would feel during the procedure, and to prove that awake intubation can be done without complicated nerve block injections or fragile equipment, such as a bronchoscope.

[Click Here to See the Video and Read More]

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