....ok, now this thing is on a roll...
A great case report in the EMJ from HEMS (Helicopter Emergency Medical Services) in London, UK.
Cyclist vs van. Severe face and head injuries. Great passers by kept him on his side so he could maintain an airway, the (BLS) paramedics did the same, keeping his airway drained. HEMS arrive with ALS paramedic and physician on board.
Intubation is predicted to be difficult. Patient is not tolerating the mask (getting agitated), so he is difficult to pre-oxygenate. So they sedate and analgese him with ketamine.....he tolerates the mask....is as pre-oxygenated as possible....they keep him on his side until they are at the point of passing the ET tube.
A description of great teamwork, great pre-hospital care and how common sense and basic airway techniqes kept him alive......then followed by 'sedation to allow oxygenation' prior to (?D)SI
Well, I would like to say you heard it here first.....but the chatter has been around for a little while now......I guess I can say that it was a couple of years ago that I was trying to start a movement to take the 'Rapid' out of the term 'Rapid Sequence Intubation'
Scott Weingart writes well on this topic......and may have been the first to coin the phrase 'Delayed Sequence Intubation'.......which is so appealing.
Read this paper on pre-oxygenation......learn what 'apnoeic oxygenation' can do for you, and your blood pressure when that next tricky airway comes along.
Here's some more comments on the same
Enjoy.....it's like a breath of fresh air.....