Delayed sequence intubation - Revision history

Elcatracho: /* See Also */

2021-02-23T19:42:05Z

Elcatracho: /* Equipment Needed */

2021-02-23T19:41:10Z

Equipment Needed

← Older revision		Revision as of 19:41, 23 February 2021
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	**Paralytic agent		**Paralytic agent
	*Laryngoscope (type based on clinical indication and provider preference/experience)		*Laryngoscope (type based on clinical indication and provider preference/experience)
	**Direct laryngoscope with blade of provider's choice '''or'''		**[[Direct laryngoscope]] with blade of provider's choice '''or'''
	**Video laryngoscope (Glidescope, C-Mac, KingVision, etc.) '''or'''		**[[Video laryngoscope]] (Glidescope, C-Mac, KingVision, etc.) '''or'''
	**Fiberoptic device		**Fiberoptic device
	*Endotracheal tube		*Endotracheal tube
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	*Ventilator		*Ventilator
	*Suction		*Suction
	*Intubation adjuncts (bougie, lighted stylet, etc)		*Intubation adjuncts ([[bougie]], lighted stylet, etc)
	*BVM		*BVM
	*[[OPA]]/NPA		*[[OPA]]/NPA

Elcatracho: /* Indications */

2021-02-23T19:39:58Z

Indications

← Older revision		Revision as of 19:39, 23 February 2021
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	==Indications==		==Indications==
	*Patients requiring intubation but are unable to tolerate preoxygenation due to altered mental status, severe hypoxemia, agitation, or other ~~reason~~		*Patients requiring intubation but are unable to tolerate preoxygenation due to altered mental status, severe hypoxemia, agitation, or other reasons
	**Likely safe for use in pediatrics<ref>Löllgen RM, Webster P, Lei E, Weatherall A. Delayed sequence intubation for management of respiratory failure in a 6-year-old child in a paediatric emergency department. Emerg Med Australas. 2014 Jun;26(3):308-9. doi: 10.1111/1742-6723.12196. Epub 2014 Apr 8. PubMed PMID: 24712856.</ref>		**Likely safe for use in pediatrics<ref>Löllgen RM, Webster P, Lei E, Weatherall A. Delayed sequence intubation for management of respiratory failure in a 6-year-old child in a paediatric emergency department. Emerg Med Australas. 2014 Jun;26(3):308-9. doi: 10.1111/1742-6723.12196. Epub 2014 Apr 8. PubMed PMID: 24712856.</ref>
	*Patients who require an additional procedure prior to intubation (i.e., NGT placement for GI ~~bleeding~~)<ref>Weingart SD, Levitan RM. Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med. 2012 Mar;59(3):165-75.e1. Epub 2011 Nov 3. Review. PubMed PMID: 22050948.</ref>		*Patients who require an additional procedure prior to intubation (i.e. NGT placement for [[GI bleed]])<ref>Weingart SD, Levitan RM. Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med. 2012 Mar;59(3):165-75.e1. Epub 2011 Nov 3. Review. PubMed PMID: 22050948.</ref>

	==Contraindications==		==Contraindications==

Elcatracho: /* Procedure */

2020-11-25T17:36:45Z

Procedure

← Older revision		Revision as of 17:36, 25 November 2020
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	*Be prepared for failed airway/deterioration		*Be prepared for failed airway/deterioration
	*Patient on cardiac monitor with pulse oximetry (preferably waveform [[Capnography\|capnography]])		*Patient on cardiac monitor with pulse oximetry (preferably waveform [[Capnography\|capnography]])
	*Apply non-rebreather mask and nasal cannula~~, set flow~~ to 15 L/min each		*Apply non-rebreather mask at flush rate and nasal cannula to 15 L/min each
	*Administer induction agent,		*Administer induction agent,
	**Ideally [[Ketamine\|ketamine]] 1-2mg/kg given mp blunting of patient respirations or airway reflexes<ref>Weingart SD. Preoxygenation, reoxygenation, and delayed sequence intubation in the emergency department. J Emerg Med. 2011 Jun;40(6):661-7. Epub 2010 Apr 8. Review. PubMed PMID: 20378297.</ref>		**Ideally [[Ketamine\|ketamine]] 1-2mg/kg given mp blunting of patient respirations or airway reflexes<ref>Weingart SD. Preoxygenation, reoxygenation, and delayed sequence intubation in the emergency department. J Emerg Med. 2011 Jun;40(6):661-7. Epub 2010 Apr 8. Review. PubMed PMID: 20378297.</ref>

Rossdonaldson1 at 21:10, 4 June 2020

2020-06-04T21:10:31Z

← Older revision		Revision as of 21:10, 4 June 2020
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	==Background==		==Background==
	*~~For patients requiring [[Intubation\|intubation]] who are agitated, have [[Altered mental status\|alterations~~ in ~~mental status]], or are otherwise unable~~ to ~~tolerate prexoygenation (whether via nasal cannula, nonrebreather mask, bag-valve mask, or [[noninvasive ventilation\|non-invasive positive pressure ventilation]]) pose a unique challenge~~ to ~~emergency clinicians~~.<ref>Weingart SD, Trueger NS, Wong N, Scofi J, Singh N, Rudolph SS. Delayed Sequence Intubation: A Prospective Observational Study. Ann Emerg Med. DOI: http://dx.doi.org/10.1016/j.annemergmed.2014.09.025</ref>		*Maximizes preoxygenation in an effort to minimize hypoxemia and adverse events related to the apneic period during intubation.<ref>Weingart SD, Trueger NS, Wong N, Scofi J, Singh N, Rudolph SS. Delayed Sequence Intubation: A Prospective Observational Study. Ann Emerg Med. DOI: http://dx.doi.org/10.1016/j.annemergmed.2014.09.025</ref>
	*Maximizes preoxygenation in an effort to minimize hypoxemia and adverse events related to the apneic period during intubation.
	*Similar to [[Procedural sedation\|procedural sedation]], except the procedure is preoxygenation itself.		*Similar to [[Procedural sedation\|procedural sedation]], except the procedure is preoxygenation itself.

Rossdonaldson1: /* Background */

2020-06-04T21:10:01Z

Background

← Older revision		Revision as of 21:10, 4 June 2020
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	==Background==		==Background==
	*For patients requiring [[Intubation\|intubation]] who are agitated, have [[Altered mental status\|alterations in mental status]], or are otherwise unable to tolerate prexoygenation (whether via nasal cannula, nonrebreather mask, bag-valve mask, or [[~~Noninvasive~~ ventilation\|non-invasive positive pressure ventilation ~~(NIPPV)~~]]) pose a unique challenge to emergency clinicians.<ref>Weingart SD, Trueger NS, Wong N, Scofi J, Singh N, Rudolph SS. Delayed Sequence Intubation: A Prospective Observational Study. Ann Emerg Med. DOI: http://dx.doi.org/10.1016/j.annemergmed.2014.09.025</ref>		*For patients requiring [[Intubation\|intubation]] who are agitated, have [[Altered mental status\|alterations in mental status]], or are otherwise unable to tolerate prexoygenation (whether via nasal cannula, nonrebreather mask, bag-valve mask, or [[noninvasive ventilation\|non-invasive positive pressure ventilation]]) pose a unique challenge to emergency clinicians.<ref>Weingart SD, Trueger NS, Wong N, Scofi J, Singh N, Rudolph SS. Delayed Sequence Intubation: A Prospective Observational Study. Ann Emerg Med. DOI: http://dx.doi.org/10.1016/j.annemergmed.2014.09.025</ref>
	*Maximizes preoxygenation in an effort to minimize hypoxemia and adverse events related to the apneic period during intubation.		*Maximizes preoxygenation in an effort to minimize hypoxemia and adverse events related to the apneic period during intubation.
	*Similar to [[Procedural sedation\|procedural sedation]], except the procedure is preoxygenation itself.		*Similar to [[Procedural sedation\|procedural sedation]], except the procedure is preoxygenation itself.

Rossdonaldson1: /* Background */

2020-06-04T21:09:40Z

Background

← Older revision		Revision as of 21:09, 4 June 2020
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	==Background==		==Background==
	*For patients requiring [[Intubation\|intubation]] who are agitated, have [[Altered mental status\|alterations in mental status]], or are otherwise unable to tolerate prexoygenation (whether via nasal cannula, nonrebreather mask, bag-valve mask, or [[Noninvasive ventilation\|non-invasive positive pressure ventilation (NIPPV)]]) pose a unique challenge to emergency clinicians.		*For patients requiring [[Intubation\|intubation]] who are agitated, have [[Altered mental status\|alterations in mental status]], or are otherwise unable to tolerate prexoygenation (whether via nasal cannula, nonrebreather mask, bag-valve mask, or [[Noninvasive ventilation\|non-invasive positive pressure ventilation (NIPPV)]]) pose a unique challenge to emergency clinicians.<ref>Weingart SD, Trueger NS, Wong N, Scofi J, Singh N, Rudolph SS. Delayed Sequence Intubation: A Prospective Observational Study. Ann Emerg Med. DOI: http://dx.doi.org/10.1016/j.annemergmed.2014.09.025</ref>
	*Weingart, et al, propose a "delayed-sequence intubation"<ref>Weingart SD, Trueger NS, Wong N, Scofi J, Singh N, Rudolph SS. Delayed Sequence Intubation: A Prospective Observational Study. Ann Emerg Med. DOI: http://dx.doi.org/10.1016/j.annemergmed.2014.09.025</ref> ~~approach to maximize~~ preoxygenation in an effort to minimize hypoxemia and adverse events related to the apneic period during intubation. Similar to [[Procedural sedation\|procedural sedation]], except the procedure is preoxygenation itself.		*Maximizes preoxygenation in an effort to minimize hypoxemia and adverse events related to the apneic period during intubation.
			*Similar to [[Procedural sedation\|procedural sedation]], except the procedure is preoxygenation itself.

	==Indications==		==Indications==

Rossdonaldson1: /* Background */

2020-06-04T21:08:48Z

Background

← Older revision		Revision as of 21:08, 4 June 2020
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	==Background==		==Background==
	~~Patients~~ requiring [[Intubation\|intubation]] who are agitated, have [[Altered mental status\|alterations in mental status]], or are otherwise unable to tolerate prexoygenation (whether via nasal cannula, nonrebreather mask, bag-valve mask, or [[Noninvasive ventilation\|non-invasive positive pressure ventilation (NIPPV)]]) pose a unique challenge to emergency clinicians. Weingart, et al, propose a "delayed-sequence intubation"<ref>Weingart SD, Trueger NS, Wong N, Scofi J, Singh N, Rudolph SS. Delayed Sequence Intubation: A Prospective Observational Study. Ann Emerg Med. DOI: http://dx.doi.org/10.1016/j.annemergmed.2014.09.025</ref> approach to maximize preoxygenation in an effort to minimize hypoxemia and adverse events related to the apneic period during intubation. Similar to [[Procedural sedation\|procedural sedation]], except the procedure is preoxygenation itself.		*For patients requiring [[Intubation\|intubation]] who are agitated, have [[Altered mental status\|alterations in mental status]], or are otherwise unable to tolerate prexoygenation (whether via nasal cannula, nonrebreather mask, bag-valve mask, or [[Noninvasive ventilation\|non-invasive positive pressure ventilation (NIPPV)]]) pose a unique challenge to emergency clinicians.
			*Weingart, et al, propose a "delayed-sequence intubation"<ref>Weingart SD, Trueger NS, Wong N, Scofi J, Singh N, Rudolph SS. Delayed Sequence Intubation: A Prospective Observational Study. Ann Emerg Med. DOI: http://dx.doi.org/10.1016/j.annemergmed.2014.09.025</ref> approach to maximize preoxygenation in an effort to minimize hypoxemia and adverse events related to the apneic period during intubation. Similar to [[Procedural sedation\|procedural sedation]], except the procedure is preoxygenation itself.

	==Indications==		==Indications==

Rossdonaldson1: /* See Also */

2019-02-02T14:22:39Z

Rossdonaldson1: /* See Also */

2019-02-02T14:10:27Z

← Older revision		Revision as of 19:42, 23 February 2021
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	==See Also==		==See Also==
			*[[Ketamine]]
			*[[Laryngospasm]]
	{{Related Difficult Airway Pages}}		{{Related Difficult Airway Pages}}

← Older revision		Revision as of 14:22, 2 February 2019
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	==See Also==		==See Also==
	*[[Deterioration After Intubation (DOPE)]]

	{{Related Difficult Airway Pages}}		{{Related Difficult Airway Pages}}

← Older revision		Revision as of 14:10, 2 February 2019
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	==See Also==		==See Also==
	*[[Supraglottic airway]]
	*[[Cricothyrotomy]]
	*[[Deterioration After Intubation (DOPE)]]		*[[Deterioration After Intubation (DOPE)]]
	*[[EBQ:Effect_of_video_laryngoscopy_on_trauma_patient_survival\|DL vs VL]]

	{{~~Mechanical ventilation pages~~}}		{{Related Difficult Airway Pages}}

	==References==		==References==