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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Wednesday, July 18, 2018

Airway Sans Hypotension

Taming The SRU - By Renne C - July 18, 2018

Insofar as Dr. Bill Hinckley has wisely coined the term "Definitive Airway Sans Hypoxia on the 1st Attempt" (DASH-1A). I humbly submit a similar goal in terms of hemodynamics: "Definitive Airway Sans Hypotension on the 1st Attempt." While tongue-in-cheek, it is a somber reminder of the dangers of definitive airway management. If done carelessly in shocked patients, intubation can become an iatrogenic catastrophe. However, performed carefully and with a comprehensive approach, even a shocked patient can be intubated safely:
  1. Resuscitate before you intubate: fluids, products, ino/pressors as needed
  2. Induce with ketamine 0.5-1 mg/kg to avoid sympatholysis, or forego an induction agent if the patient is truly obtunded
  3. Minimize positive pressure and extrinsic PEEP while watching for intrinsic PEEP
  4. Preserve the ventilatory compensation of metabolic acidosis to avoid dropping the pH and causing hemodynamic collapse
Through a deep respect for its perils and a thoughtful deployment of the above strategies, you can successfully circumnavigate the hemodynamic storm clouds of intubation. In doing so, know that you have accomplished one of the greatest challenges of Emergency Medicine and Critical Care: not harming patients in an attempt to save them!"