Tuesday, September 27, 2016

Resuscitation Sequence Intubation

Resuscitation Sequence Intubation - Hypotension Kills
R.E.B.EL.EM - Posted by Salim Rezaie - September 26, 2016
"This blog post is the first part of a series of 3, on a recent lecture I was asked to give on Critical Care Updates: Resuscitation Sequence Intubation. This talk was mostly derived from a podcast by Scott Weingart (Twitter: @EMCrit) where he talked about the physiologic killers during preintubation and perintubation. In this podcast, Scott mentions the HOp killers: Hypotension, Hypoxemia, and Metabolic Acidosis (pH) as the physiologic causes of pre-intubation/peri-intubation morbidity and mortality. Taking care of these critically ill patients that require intubation can be a high stress situation, with little room for error. In part one of this series we will discuss some useful strategies at the bedside to help us reduce pre-intubation/peri-intubation hypotension...
Clinical Bottom Line:
  • Pre-Intubation Hypotension (SBP ≤90mmHg) is a risk factor for Peri-Intubation Cardiac Arrest:
  • Options to Improve Hemodynamics:
    • Don’t Forget the Basics (i.e. IVF)
    • Intervention 1: Use ROCKETamine, Dose Induction Agents Low and Paralytic Agents High
    • Intervention 2a: Use Push Dose Epinephrine
    • Intervention 2b: Use Peripheral Vasopressors Prior to Intubation
    • Intervention 3: If Time Permits, Perform the Awake Intubation
  • Many of these interventions can be done simultaneously to ensure no hemodynamic instability"