Urgent/emergent intubation in the non-cardiac arrest patient.
There are many indications to intubate. The following are some examples:
-Respiratory failure eg severe COPD, CCF in patients for whom non-invasive ventilation (BiPAP, CPAP) is not appropriate or not effective.
-Airway protection eg. obtunded patient unable to protect their own airway.
-Neuroprotection - head injury, reduce cerebral metabolism
-Transport - protecting an airway for transport.
There are potentially many contraindications. The following are the common examples. Pros and cons / risks and benefits should be weighed.
-Patient who is haemodynamically unstable in whom we need to do more work to optimize their physiology beforehand. If still unstable - consider 'awake intubation'.
-Allergy to planned medications.
-Predicted difficult airway (=relative contradindication). Consider doing 'awake intubation'
-Inadequate number of personnel present (=relative contraindication)
The CARE Course cards and checklists - linked in this section.
Review cards for predicting difficult airway (laryngoscopy, BVM ventilation, rescue device, surgical airway)
Review the steps of the procedure - on this card
Consider whether an awake 'look' / awake intubation might be preferable (difficult airway anatomically or physiologically 'very shocked' patent who might be better continuing to breathe on their own, thus preserving their preload)
Optimize patient's physiology: BP/ volume , oxygenation
Use the cards linked above to take you through the procedure
Rushing
Not optimizing patients physiology prior to intubation - BP/volume, oxygenation
Intubating the acidotic, tachypnoeic patient and then not being able to ventilate them as well as they were ventilating on their own - resulting in increased acidosis
Not considering awake intubation
Not using the checklists and getting the room quiet and into "sterile cockpit' prior to pushing the drugs
Rescue airway device / BVM or emergency cricothyroidotomy.
Re-attempt endotracheal intubation - improve patient position, bigger blade, video laryngoscopy