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Awake Intubation the EMCrit Way

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SMACC Conference
SMACC Conference

Scott Weingart revisits his famous video, illustrating how awake intubation can be done efficiently and effectively, with the proper preparation.

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Awake Intuba tion
When is this a good idea?
Apneic RSI Awake Crash Tough YesNo Yes No
Apneic RSI Awake Crash Tough YesNo Yes No
Why is this a good idea?
Cases
Any predicted difficult airway that isn’t crash
Awake Intubation
Dry ‘em out Topicalize Sedate Ready the Patient Intubate
Dry ‘em out Topicalize Sedate Ready the Patient Intubate
Dry ‘em out Topicalize Sedate Ready the Patient Intubate
Dry ‘em out Topicalize Sedate Ready the Patient Intubate
Dry ‘em out Topicalize Sedate Ready the Patient Intubate
Dry ‘em Out
Antisialagogue (Choose 1) · Glycopyrolate 0.2-0.4 mg IV Atropine 0.5-1 mg IV ·
Dry ‘em Out
Suction and Pad Dry
My Residents
Topicalize
5 ml of 4% Lidocaine nebulized @ 5 LPM
My resident, Raghu, was teased for months for that last suctioning Sorry, Raghu!
Spray the back of the oropharynx if necessary
I should have smurfed the methylene blue!
Mucosal Atomization Device
Lido Lollipop
Consider anesthetizing below the cords
TransTracheal Injection (optional) 3cc of 4% Lidocaine
MAD Below Cords (optional) 3cc of 4% Lidocaine
Be aware of anesthesia toxicity
Sedate
Versed 2 mg
Dexmedetomidine
Remifentanil
Ketamine Alone (10 mg Aliquots)
Ketofol 75% Ketamine and 25% Propofol in a syringe (15/5 cc of each)
Preoxygenate
Nasal Cannula
Optimally Position the Patient
Optimally Position the Patient R. Levitan
Restrain the Patient
Switch to just the Nasal Cannula
Equipment check Fiberoptic Laryngoscope/Stylet Bougie 8-0 Tube 7-0 Tube Extra Ketofol LMA Cric Set-up Paralytic Syringe with MAD with 4% Suction/BVM/ETCO2
Extra Meds with someone to push them
Intubate
Minimize Touching
1. Fiberoptic Bronch 2. Fiberoptic Stylet 3. Video Laryngoscope 4. Standard Laryngoscope
2. Fiberoptic Stylet
1. Fiberoptic Bronch 2. Fiberoptic Stylet 3. Video Laryngoscope 4. Standard Laryngoscope
1. Fiberoptic Bronch 2. Fiberoptic Stylet 3. Video Laryngoscope 4. Standard Laryngoscope
1. Fiberoptic Bronch 2. Fiberoptic Stylet 3. Video Laryngoscope 4. Standard Laryngoscope
Rudy Malmquist
Have a Backup Plan and a Failure Plan
Backup Plan
Retrograde Intubation
Failure Plan
RSI LMA Cric
Post-Tube Care
To Review
Dry ‘em out Topicalize Sedate Ready the Patient Intubate
Dry ‘em out Topicalize Sedate Ready the Patient Intubate
Dry ‘em out Topicalize Sedate Ready the Patient Intubate
Dry ‘em out Topicalize Sedate Ready the Patient Intubate
Dry ‘em out Topicalize Sedate Ready the Patient Intubate
AWAKE INTUBATION LEAVES YOU IN CONTROL!
Awake Intubation the EMCrit Way
Awake Intubation the EMCrit Way

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