Equipment to have Bedside
- VL
- Suction
- New Same-Sized Empty ETT
- Additional ETTs
- Syringe
- Tube Exchanger (Cook CAE19 for ETT 7 or larger; CAE15 for ETT 5-6.5)
- BronchPort
- Tons of lube
- Bougie or Glidescope Stylet depending on your VL choice
- SGA and Scalpel
- ETCO2 with Waveform
- BVM
- If you have one available, a Bronchoscope is a wonderful bonus esp. if it can fit an Aintree catheter
A Video from AirwayOnDemand
Literature
- [cite source='pubmed']19299792[/cite]
- Please Use VL if it is available [PMID: 26111264]
Now on to the Wee…
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- EMCrit 373 – Mike Weinstock with another Critical Care Bounceback: “Asymptomatic Hypertension” - April 18, 2024
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Can’t agree more with this post.
A common approach is to blindly exchange the ETT. This will almost always work, but occasionally will fail miserably. The failure rate is low enough that this method continues to be used and taught.
Changing out the ETT with under crystal-clear vision with VL seems safer. Sometimes this approach has been criticized as unnecessary. However, given a choice I’d rather be over-prepared.
Agree with Dr Farkas – my practice is always to have direct visualization of the procedure, whether using a bougie or exchange catheter device. Have seen one too many (one is enough!) times when the bougie has inadvertently been malpositioned into the esophagus when the old tube comes out.
Thanks for the great post!
Zaf Qasim
@emeddoc
Thanks for another great post!
I’ve never used an airway exchanger. We don’t have them at my service. I’ve had great success with the combination of VL (King Vision) and bougie.
Keep fighting the good fight, Scott.
Great talk – very important to address a seemingly easy situation which if not handled carefully may turn out as a disaster.
Remember “assumption is the mother of all f… ups
A few tips from my point of view:
Stage one should be preoxygenation – dial up the fio2
Turn up the sedation, analgesia and give relaxation before commencing any airway procedures. This may improve your view and blunted any effects of airway management, both hemodynamic and upper airway reactivity (laryngeal spasm)
absolutely! thanks, brother.
Thanks! Just finished a CCM fellowship and didn’t get much teaching on this (structured or otherwise) so this is great. Between you and Josh’s recent posts I feel prepared to handle this.
Question – why not just use the bronch every time? It seems like the disposable bronchs are more common than they were 7 years ago (when you originally posted), has your practice changed? It sounds like your method with ventilating the AEC is quite foolproof but direct visualization may be even better.
blog is mentioned several times for show notes, where is the blog link?
you are on it : )