Managing high fluid airway situations

Collected tweets on managing persistent flooding of the airway with fluids (blood or gastric fluids)

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Definitive airway on BMI 92 hypoxic hypercapnic respiratory failure

Some time ago, in this galaxy, ourabg good friend Jorge Cabrera was faced with managing respiratory failure in a 55’ish year old man with BMI of 92 (ht 6 feet, wt 675 lbs (307kg). This patient was initially admitted with an upper gastrointestinal bleed with congestive heart failure and a history of obstructive sleep apnea. He had required mechanical ventilation but was weaned off recently. His recent intubation involved 2 attempts by anesthesia with the first attempt being  failed Mac 3 direct laryngoscopy and the second attempt being a successful glidescope intubation.

The patient was now in hypercapnic hypoxic respiratory failure despite all treatment including NIPPV. His arterial blood gas was not improving despite CPAP or BiPAP (EPAP of 12).

pH 7.1 PaCO2 90’s PaO2 60’s SaO2<90’s

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Training Airway Decontamination: the Flip Side of Ventilation Centered Airway Approach

SALAD 1In airway management, oxygenation and ventilation are the overriding priorities and fluids in the airway must be avoided and managed at all costs.

It’s not about plastic in the trachea

– Rich Levitan (@airwaycam)

Continue reading “Training Airway Decontamination: the Flip Side of Ventilation Centered Airway Approach”