This week’s video analysis is with epic guest commentator Dr. Haney Mallemat (@criticalcarenow), while at Castlefest/Resusfest 2017, a critical care and ultrasound conference held in Lexington, Ky. In part one of two, we discuss a difficult code intubation and a burned airway, both perilous in their own way. Check out Dr. Mallemat’s take on these challenges.
Pearls from this week’s difficult airways:
- Chest compressions should be the priority during cardiopulmonary resuscitation; alternatives to intubation can successfully ventilate and oxygenate without prolonging time off the chest.
- Have help when keeping track of time during an arrest- your attempt at intubation may be depriving your patient of compressions or adequate respiratory support.
- A bougie can help to secure a bouncing, coding airway.
- Burned airways can get edematous quickly and are prone to worsen with multiple attempts, have your bougie, smaller tube and scalpel bedside.
- Prep your room. Have everyone on the same page before shit hits the fan with a difficult airway.
References:
Video laryngoscopy vs. direct laryngoscopy: Which should be chosen for endotracheal intubation during cardiopulmonary resuscitation? A prospective randomized controlled study with experienced intubators. JW Kim, S Park. Resuscitation 2016. 105: 196-202.
Association between tracheal intubation during adult in-hospital cardiac arrest and survival. Anderson et al. JAMA. 317: 494-506.
Read my review of this article here.
