Push Dose Pressor Labels/Orders

During a slower emerg shift on Christmas day 2015, I finally designed push dose pressor labels and sticker orders/instructions for mixing that work with the labels in our emergency department. I use these for resuscitations and teaching.

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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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Recipe for SALAD (Suction Assisted Laryngoscopy Airway Decontamination) Simulation AKA “VomiQuin”

Make electrical safety a top priority with this setup, please.

Here are the basic construction instructions to create the Suction Assisted Laryngoscopy Airway Decontamination (SALAD) simulator (AKA “VomiQuin”) from the airwayNatic @jducanto.

SALAD simulation setup

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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)

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Bougie-Assisted Tactile Blind Digital Intubation

Yen Chow and Jorge Cabrera [Updated Sept 21, 2015]

A cardiac arrest has been called on the floor and you happen to arrive before the crash cart. CPR is in progress and mask ventilation is being performed with an oral airway. A lot of suctioning is required for vomit in the airway. There is difficulty ventilating despite optimizing position, two person bag-valve-mask ventilation, additional nasal airways and maximal jaw thrust. There is limited access to the head of the bed in the patient’s room. As an airway clinician on the code blue team you carry a bougie and a cuffed 6.0 endotracheal tube with you. Bougie assisted blind digital intubationIntubation and extraglottic airway equipment still has not arrived. Pulling out your bougie and tube, you take out the patient’s dentures and use the oral airway as a bite block. You find the epiglottis with your middle and index fingers inserted into the mouth and guide the bougie into the glottic opening feeling tracheal ticks and hold-up to confirm. The tube slides over the bougie. Successful ventilation occurs without chest compressions missing a beat and the code continues.

 

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