Rural Emergency Room Simulation Teaching and Education Resource

Intubations in the ER have become 'disease specific' so that 'one induction agent one paralytic' no longer applies. 
The Power Point below discusses intubation of the normotensive, neurologically intact, the hypotensive, the asthmatic and the increased intracranial pressure patient with the different approaches for each.
Obviously this does not cover all clinical scenarios that one might encounter in the ER, but it covers the more serious ones in which the way intubation is carried out can have a major impact on patient outcome.

 

Intubations in the ER.pptx Intubations in the ER.pptx
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Type : pptx
RSI Checklist.doc RSI Checklist.doc
Size : 45 Kb
Type : doc
Strayer Intubation checklist.doc Strayer Intubation checklist.doc
Size : 1340 Kb
Type : doc

A recent article on using high flow oxygen during intubation

Am J Respir Crit Care Med. 2015 Oct 1.

Randomized Trial of Apneic Oxygenation during Endotracheal Intubation of the Critically Ill.

Semler, Matt et al

Hypoxemia is common during endotracheal intubation of critically ill patients and may predispose to cardiac arrest and death. Administration of supplemental oxygen during laryngoscopy (apneic oxygenation) may prevent hypoxemia.

OBJECTIVES:

To determine if apneic oxygenation increases the lowest arterial oxygen saturation experienced by patients undergoing endotracheal intubation in the intensive care unit.

METHODS:

A randomized, open-label, pragmatic trial in which 150 adults undergoing endotracheal intubation in a medical intensive care unit were randomized to receive 15 L/min of 100% oxygen via high-flow nasal cannula during laryngoscopy (apneic oxygenation) or no supplemental oxygen during laryngoscopy (usual care). The primary outcome was lowest arterial oxygen saturation between induction and two minutes after completion of endotracheal intubation.

MEASUREMENTS AND MAIN RESULTS:

Median lowest arterial oxygen saturation was 92% with apneic oxygenation versus 90% with usual care (95% confidence interval for the difference -1.6% to 7.4%; P = .16). There was no difference between apneic oxygenation and usual care in incidence of oxygen saturation < 90% (44.7% versus 47.2%; P = .87), oxygen saturation < 80% (15.8% versus 25.0%; P = .22), or decrease in oxygen saturation > 3% (53.9% versus 55.6%; P = .87). Duration of mechanical ventilation, intensive care unit length of stay, and in-hospital mortality were similar between study groups.

CONCLUSIONS:

Apneic oxygenation does not appear to increase lowest arterial oxygen saturation during endotracheal intubation of critically ill patients compared to usual care. These findings do not support routine use of apneic oxygenation during endotracheal intubation of critically ill adults.

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