1. patientsafe

    July 19, 2017 at 7:01 am

    Hi Traudi, Very interesting post. Keep up the great work. I note you preoxygenated the patient with bowel obstruction using a NRM. Did you consider using a face mask seal with self inflating bag? Also did you have access to capnography and/or ETO2 monitoring during this preoxygenation phase and would you consider it to be of any benefit in this setting? If you’ve time perhaps check out this post: http://wp.me/p8r3e4-eJ I’d be most interested in your thoughts. Thanks. Rob Hackett

    • Traudi Almhofer

      July 19, 2017 at 1:51 pm

      Hi Rob, thanks for reading my post! You are right – use of a self inflating bag and mask in a ward setting is my standard practice, allowing me to deliver 100% FiO2 with PEEP. We did attempt this initially, however the gentleman was simply not tolerating this – whether he was claustrophobic, combative due to cerebral hypoxia, or perhaps even unable to generate enough negative pressure to overcome the resistance of the one way valve, it was clear that using the self inflating bag was not going to be an option for us at this time. Nonetheless, we decided some oxygen was better than none, hence the NRM. ETO2 would be ideal, although I am yet to come across it outside of theatre and intensive care. As for capnography, the ward crash cart was stocked with single use colorimetric CO2 monitors, which we did use to confirm placement of the ETT, however these are of little use in assessing adequacy of pre-oxygenation. Ideally, in a controlled setting in theatre, one would deliver 100% FiO2 via a well fitted mask and closed breathing circuit, with ETO2 monitoring to assess the degree of denitrogenation, and capnography to assess the integrity of your closed circuit – but a peri-arrest situation in an unfamiliar ward mandates a more flexible, (although equally careful) approach. Cheers. Traudi Almhofer

  2. Bruce

    July 23, 2019 at 1:57 pm

    I am unclear why this man needs awake intubation when you have successfully intubated him, under significant pressure, first time. A large neck and a less than ideal view is part and parcel of a day’s work for us. I intubate said “difficult airways” all the time. In the setting of a controlled theatre environment, with all the kit around if necessary, we invariably get a usable view and an easy tube. I would advise against inflicting awake procedures on people, especially those with coexistence morbidity, when you have already demonstrated that a good gasperson will not struggle at all. Easy!

    • Harris

      March 10, 2020 at 12:18 am

      It’s a different patient with a previously known difficult airway. Not the crash intubation from the ward.


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