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Q Tips – March 2010

Tips from your diligent peer review committee.
1. When a patient has copious ongoing bleeding, and is hypotensive, consider giving blood. The blood bank can provide un-crossmatched blood very quickly if necessary.
2. When a patient who has a very low blood pressure requires intubation, consider improving the blood pressure prior to performing intubation, as the transition to positive pressure and pharmacologic sympatholysis that accompanies RSI often further depress blood pressure. Intravenous fluids and pressors are two strategies. Phenylephrine 10 mg/1 cc vials, are now available in both the adult and pediatric med rooms at Sinai.
3. In patients who require intubation but cannot be preoxygenated effectively, or in patients who require high minute ventilation to maintain physiologic pH, consider maneuvers to improve oxygenation/ventilation around RSI if an awake approach is not predicted to be successful. These maneuvers include BVM or NIV before, during, and after induction, perhaps using an LMA (after induction). Short laryngoscopy times and first pass success are more important in these patients – choose your approach and intubator accordingly.

Tips from your diligent peer review committee.

1. When a patient has copious ongoing bleeding, and is hypotensive, consider giving blood. The blood bank can provide un-crossmatched blood very quickly if necessary.

2. When a patient who has a very low blood pressure requires intubation, consider improving the blood pressure prior to performing intubation, as the transition to positive pressure and pharmacologic sympatholysis that accompanies RSI often further depress blood pressure. Intravenous fluids and pressors are two strategies. Phenylephrine 10 mg/1 cc vials, are now available in both the adult and pediatric med rooms at Sinai.

3. In patients who require intubation but cannot be preoxygenated effectively, or in patients who require high minute ventilation to maintain physiologic pH, consider maneuvers to improve oxygenation/ventilation around RSI if an awake approach is not predicted to be successful. These maneuvers include BVM or NIV before, during, and after induction, perhaps using an LMA (after induction). Short laryngoscopy times and first pass success are more important in these patients – choose your approach and intubator accordingly.

Written by reuben

March 11th, 2010 at 2:13 pm

Posted in Pearls

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