In this scenario, intubation was managed by our second year resident, Michael Elliott. A 53 year old obese male presented “requesting a nebulizer.” Although he initially improved with minimal intervention, the patient quickly decompensated. He became hypoxic, altered and combative within moments and in the process lost all IV access. So not only was this a difficult intubation, it proved to be a “difficult pre-oxygenation” as well. Watch and see how this all unfolds.
Michael’s Take Home Points:
- Know when RSI is the wrong choice; DSI is meant to help preoxygenate the altered patient who won’t tolerate oxygen by NC, NRB or PPV.
- Ketamine can be given IV, IO or IM
- Have your bougie ready- multiple attempts with the ETT can cause airway edema, consider your bougie early
- If you think it will work, try it. This includes reversing the bougie. Don’t try the same failure technique over and over. Recognize when something isn’t working.