In Podcast 104, we discussed how to avoid killing hemodynamically unstable patients while intubating. Today's podcast takes that concept a step further to allow you achieve a hemodynamically neutral intubation.
The Pieces
Rapid Sequence Awake
Discussed in this podcast
or
Dissociated "Awake" Intubation
or
A Combination
then
you can consider a DSI for Hemodynamics, but only in non-tenuous patients
then
place the patients on CPAP/PSV mode with both set to zero
if the patient requires mechanical ventilatory support because they continue to decline, consider
Higher Vt/Lower Rate as per Davis et al.
and
Sedate with small hits of ketamine or fentanyl
Further Reading
* Pulmonary Hypertension Awake Intubation from CCM
Now on to the Podcast...