This week we dive into some advanced topics in RSI including patient positioning and pre-intubation resuscitation.
Episode 110.0 – Advanced RSI Topics
Show Notes
Take Home Points
- Bed up head elevated position for intubation may reduce intubation related complications.
- Patients who are hypotensive or at risk of hypotension should be aggressively resuscitation prior to intubation with fluids and liberal use of pressors
- Shock patients would be intubated with decreased induction agent dose, preferably ketamine, and increased paralytic dose.
Bed-Up-Head-Elevated Positioning
Show Notes
EMCrit: Podcast 104 – Laryngosocpe as a Murger Weapon (LAMW) Series – Hemodynamic Kills
Life in the Fastlane: Intubation, hypotension and shock
Core EM: Bed Up Head Elevated Position for Airway Management Video
REBEL EM: Critical Care Updates: Resuscitation Sequence Intubation – Hypotension Kills (Part 1 of 3)
ALiEM: The Dirty Epi Drip: IV Epinephrine When You Need It
emDocs: Roc Rocks and Sux Sucks! Why Rocuronium is the Agent of Choice for RSI
Swaminathan A, Mallemat H. Rocuronium Should Be the Default Paralytic in Rapid Sequence Intubation. Ann Emerg Med 2017. PMID: 28601274
Khandelwal N et al. Head-Elevated Patient Positioning Decreases Complications of Emergent Tracheal Intubation in the Ward and Intensive Care Unit. Anesth Analg 2016; 122(4): 1101-7. PMID: 26866753
Excellent and informative