Presentation on theme: "1 Module B: Hour 2 Intubation Difficulties. 2 Think ahead !!!! If you suspect a difficult airway: call for help early What increases the risk of a difficult."— Presentation transcript:
1 Module B: Hour 2 Intubation Difficulties
2 Think ahead !!!! If you suspect a difficult airway: call for help early What increases the risk of a difficult airway ?
3 Mallampati Is Mallampati a famous curry dish from the south of India ?
5 The 6 “P’s” of RSI Preparation (5 min) Pre-oxygenation (2 min) Paralysis / induction Protection and positioning (30 seconds) Placement (45 seconds) Post-intubation care
6 P1 = Preparation What preparations do you make before intubating ? What is “Soap Me” ?
7 P2 = Preoxygenate What are the physiological aims of pre-oxygenation ? How are these achieved ?
8 P3 = Paralysis/Induction What problems arise with the common induction agents ? Compare the use of these: Suxamethonium vs Rocuronium
9 P4 = Protection/Positioning How do you achieve in-line stabilisation if necessary ?
11 P5 = Placement How do you confirm your tube placement ?
12 P6 = Post-intubation care SedationParalysisMonitoringHumidification NG tube and IDC
13 Mrs AO, 72 years old BIBA from GP’s waiting room Sudden stridor: given adrenaline/ventolin/ phenergan/lasix at GPs for ? anaphylaxis ? APO Sats 95% on R/A on arrival, fairly comfortable. Intermittently complains of SOB, audible soft stridor, two word sentences. Epigastric pain. What is your management ?
14 Describe the X-ray
15 The patient needs a CT chest. How would you proceed ?
17 Mr DI, 73 years old GCS 7, found on floor by wife (E1 V1 M5) Increased tone /reflexes on right Increased tone /reflexes on right PEARL, but small PMHx IHD, A/F on warfarin Gurgling respirations Sats 89% on R/A, RR 16/min What is your management ?
18 You are unable to intubate – this is your view. What grade of laryngoscopy is this ?
19 Laryngoscopy What would you do next ?
20 Second look STOP, re-oxygenate, rethink BURPIntroducer BOUGIE (if you can see the epiglottis) Different blade
21 You remain unable to intubate. What would you do next ?
22 End of the line What do you do if you can’t intubate and you can’t ventilate a patient ?
23 Reminder: Nobody ever died from a failure to intubate. They died from a failure to ventilate.