HKCEM College Tutorial. Airway Management in a Comatose patient. AUTHOR DR. LAM PUI KIN, REX OCT 2013. Objectives. Recognise indications for intubation Anticipate difficult airway Preparation for RSI Procedure of RSI How to handle if you fail to intubate. Triage. M/34
DR. LAM PUI KIN, REX
Triage Category I
How would you manage his airway?
Start with ABC
GCS only 8
Lavage may be needed
Other common indications
Adjuncts to therapy
Reduce work of breathing (e.g. decompensated shock)
Situational needIndications for intubation
Other general indications for
intubating a patient
Any absolute contraindication?
No … However
predict difficult airway before initiation of paralytic agent to prevent the situation of cannot ventilate and cannot intubate (CVCI)
Event- trauma, increased ICP, asthma
How do you prepare for RSI?
Not to forget!
Full PPE in
high risk cases
Do you know where is the
difficult airway kit in
your ED ?
Do you know what is
Now, take us through the steps of RSI.
IPPV will blow up stomach and increase risk of aspiration. If time allows, spontaneous respiration is better.
Benumof JL et al. Anesthesiology 1997;87:979
Lignocaine 1 - 1.5mg/kg
Opioids - Fentanyl 1-2 mcg/kg
Atropine 0.02 mg/kg (min 0.1mg)
Defasciculation (rarely done in ED)
Operator manipulates and obtains view of larynx, then asks assistant to hold
Assistant performs BURP for operatorOELM vs BURP(optimal external laryngeal manipulation)(backward upward rightward pressure)
Esophageal Intubation (EDD)
What is the
Remember DOPE when anything goes wrong
Right Main Bronchus Intubation
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