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Module B: Hour 2

Module B: Hour 2. Intubation Difficulties. Think ahead !!!!. If you suspect a difficult airway: call for help early What increases the risk of a difficult airway ?. Mallampati. Is Mallampati a famous curry dish from the south of India ?. The 6 “P’s” of RSI. Preparation (5 min)

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Module B: Hour 2

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  1. Module B: Hour 2 Intubation Difficulties

  2. Think ahead !!!! • If you suspect a difficult airway: call for help early • What increases the risk of a difficult airway ?

  3. Mallampati • Is Mallampati a famous curry dish from the south of India ?

  4. The 6 “P’s” of RSI • Preparation (5 min) • Pre-oxygenation (2 min) • Paralysis / induction • Protection and positioning (30 seconds) • Placement (45 seconds) • Post-intubation care

  5. P1 = Preparation • What preparations do you make before intubating ? • What is “Soap Me” ?

  6. P2 = Preoxygenate • What are the physiological aims of pre-oxygenation ? • How are these achieved ?

  7. P3 = Paralysis/Induction • What problems arise with the common induction agents ? • Compare the use of these: • Suxamethonium vs Rocuronium

  8. P4 = Protection/Positioning • How do you achieve in-line stabilisation if necessary ?

  9. P5 = Placement • How do you confirm your tube placement ?

  10. P6 = Post-intubation care • Sedation • Paralysis • Monitoring • Humidification • NG tube and IDC

  11. Mrs AO, 72 years old • BIBA from GP’s waiting room • Sudden stridor: given adrenaline/ventolin/ phenergan/lasix at GPs for ? anaphylaxis ? APO • Sats 95% on R/A on arrival, fairly comfortable. • Intermittently complains of SOB, audible soft stridor, two word sentences. Epigastric pain. • What is your management ?

  12. Describe the X-ray

  13. The patient needs a CT chest. • How would you proceed ?

  14. Mr DI, 73 years old • GCS 7, found on floor by wife (E1 V1 M5) • Increased tone /reflexes on right • PEARL, but small • PMHx IHD , A/F on warfarin • Gurgling respirations • Sats 89% on R/A, RR 16/min • What is your management ?

  15. You are unable to intubate – this is your view. • What grade of laryngoscopy is this ?

  16. Laryngoscopy • What would you do next ?

  17. Second look • STOP, re-oxygenate, rethink • BURP • Introducer • BOUGIE (if you can see the epiglottis) • Different blade

  18. You remain unable to intubate. • What would you do next ?

  19. End of the line • What do you do if you can’t intubate and you can’t ventilate a patient ?

  20. Reminder: Nobody ever died from a failure to intubate. They died from a failure to ventilate.

  21. Discussion

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