Ep 22 Intubation Baby

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[audio:22_IntubationBaby.mp3] (59:47) Maybe we should have called it “everything you wanted to know about intubation but were afraid to ask”. Kelly is the Jedi Master and Ron started intubation this week. Had lots of questions to ask Kelly, so this is a long one.

Here’s some of the questions asked.
Blade Preference: Miler/Mac
Pedi Bougie
Do you have a backup device?
How do you secure the tube to the mouth/in place?
Vomit and other stuff coming out of the tube.
When do you start intubating?
Burned airway gets the most experienced medic.
Do you hold your breath while intubating?
How do you know you are in?
What drugs do you use for PAI?
What is you method for PAI?
RSI is now PAI
Do you always paralyze?
How do you pick a tube size?

Listener Questions

Christine Springfield: Intubation on a concious, non-sedated patient. Experienced that this week during clinicals and it was VERY interesting. I can see that this might be necessary in the field at some point… what are your thoughts and experiences?

Christopher
How as a relatively new medic how can I get senior “It’s always been done this way” medic to change some of their modalities of treatment?

Mentions:
Dr Michael Bailin intubating himself.
Ron’s EMS Youtube Channel.
Kelly’s Medic Math post.
Kelly’s Airway Continuum

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  • Christine

    Thanks… another great podcast.

    Concerning the awake intubation, well… I wish it had gone like the video. Instead, it involved a concious lady with a very swollen tongue, 3 anestheologists, 2 ER docs, 5 nurses, and 2 ER techs all working to slip a tube down any way possible before her airway occluded entirely. I’ll keep that butterfly with lidocaine trick up my sleeve and hope I never have to use it.

  • Anonymous

    Let me guess – angioedema from ACE inhibitors?

    That can be a cast-iron beeyotch of an airway problem.

  • Christine

    Bingo! It was quite the educational experience. How common is that? I could see it being a HUGE issue on an ambulance…

  • Anonymous

    I wouldn’t call it common, but it isn’t rare, either.

    The first one I saw was 14 years ago, back before I even knew what ACE inhibitors were. I figured I was looking at an allergic reaction of some type, and gave the patient Benadryl and Decadron, which turned out to be the right choice, given the options available to me at the time. Still, it was 95% luck. I didn’t know jack squat about the condition.

    I missed a case of angioedema a few months ago, when I got to the patient before any visible swelling began. She complained of a choking sensation and inability to swallow, but there weren’t any outward signs of angioedema at that point.