May 9, 2019

Background Information: The sequential administration of a sedative and neuromuscular blocking agent (NMBA) to facilitate the passage of an endotracheal tube is a common method of intubating in both the emergency department (ED) and intensive care unit (ICU). In fact, 85% of ED intubation and 75% of ICU intubations are performed using RSI. 1 It has been shown that the NMBA not only provides muscle relaxation to improve laryngeal view but has also reduced intubation associated complications, ultimately improving the likelihood of intubation success.2-4 While the early use of a sedative leads to hypoventilation and apnea, the patient has an increased risk of hypoxemia and delaying optimal intubation conditions.1 Use of an NMBA was associated with a lower prevalence of hypoxemia, however the order of its administration before the sedative remains controversial for fear of patient awareness and its use has been limited to the operating room (OR) setting. 1,2 The authors of this study sought to identify whether the order of RSI drugs was associated with increased apnea time during intubation. They defined this interval as the time elapsed from administration of the first RSI drug to the end of a successful first intubation attempt.

March 12, 2018

In Episode 46a we discussed respiratory failure and NIV.  In episode 46b we are going move on to the patient where you have tried NIV and your patient just doesn’t seem to be improving.  You decide to intubate your patient and connect them to the ventilator.  Now the ventilator starts beeping and your patient begins to decompensate.  What are the steps you use to assess the problem and fix it?

February 26, 2018

Imagine you have a patient in respiratory failure sitting right in front of you. The patient has an increased work of breathing and obviously in distress.  Monitors are beeping, nurses are asking you what you want to do, and if you don’t do something, the patient is going to arrest and potentially die.  What is your framework for tackling these patients?  Well, I had a chance to sit down with Haney Mallemat and discuss his framework for managing respiratory failure and NIV.