Episode 8: Emergency Airway Controversies

Emergency Medicine Cases

Dr. Anton Helman

Science, Courses, Medicine, Health & Fitness, Education

4.7 • 602 Ratings

🗓️ 7 October 2010

⏱️ 118 minutes

🔗️ Recording | iTunes | RSS

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Summary

There are so many emergency airway controversies in emergency medicine! Dr. Jonathan Sherbino, Dr. Andrew Healy and Dr. Mark Mensour debate dozens of these controversies surrounding emergency airway management. A case of a patient presenting with decreased level of awareness provides the basis for a review of the importance, indications for, and best technique of bag-valve-mask (BVM) ventilation, as well as a discussion of how best to oxygenate patients. This is followed by a discussion of what factors to consider in deciding when to intubate and some of the myths of when to intubate. The next case, of a patient with severe head injury who presents with a seizure, is the fodder for a detailed discussion of Rapid Sequence Intubation (RSI). Tips on preparation, pre-oxygenation and positioning are discussed, and some great debates over pre-treatment medications, induction agents and paralytic agents ensues. The new concept of Delayed Sequence Intubation is explained and critiqued. They review how to identify a difficult airway, how best to confirm tube placement and how to avoid post-intubation hypotension. In the last case of a morbidly obese asthmatic they debate the merits of awake intubation vs RSI vs sedation alone in a difficult airway situation and explain the best strategies of ventilation to avoid the dreaded bradysystlolic arrest in the pre-code asthmatic. Finally, some key strategies to help manage the morbidly obese patient's airway effectively are reviewed.

Transcript

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0:00.0	Welcome to Emergency Medicine Cases.com.
0:07.7	I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency
0:12.1	medicine from EMC Studios in Toronto.
0:20.1	On this episode number eight, airway controversies, we have with us Dr. Jonathan Sherbino.
0:26.1	The hard cutoff of the GCS of 8 is as useful as you find ATLSTB.
0:31.2	He's an assistant professor at McMaster University, where he is the director of continuing
0:35.2	professional development for the Division of Emergency Medicine.
0:38.3	We also have with us Dr. Andrew Healy.
0:40.9	I also don't think that a dogmatic approach where you use rules would really help the experience clinician in making that decision.
0:48.3	He's an emergency physician at St. Joseph's Hamilton and an assistant clinical professor of medicine at McMaster University.
0:55.1	He is co-founder of the evidence-based resuscitation and focused ED synography courses. We also have with us Dr.
1:01.0	Monser. The literature is certainly becoming more controversial when you look at innovation.
1:05.9	He practices emergency medicine and anesthesiology at Huntsville District Memorial Hospital
1:10.8	in South Moscow Memorial Hospital. He's an assistant professor of emergency medicine and anesthesiology at Huntsville District Memorial Hospital and South
1:11.2	Moscow Memorial Hospital. He's an assistant professor of emergency medicine for the Northern
1:15.2	Ontario School of Medicine, having lectured nationally and internationally on topics in emergency
1:19.8	medicine and anesthesiology. He is co-founder of evidence-based resuscitation and focused
1:24.9	ed sonography courses. Well, they don't call up the ABCs for
1:29.2	nothing. Managing the airway is perhaps the defining skill of the emergency physician. Without an
1:35.2	airway, you ain't got nothing. Over the past 20 years, there's been a huge shift in the way
1:40.9	emergency physicians manage the airway, and we're lucky now to have a huge amount of
1:44.8	research on emergency airway management to guide us. If you've practiced emergency medicine for more
	...

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