Cite this post as:
Scott Weingart, MD FCCM. Emergency Awake Topicalized (EAT) Intubation – An Awake Intubation Update. EMCrit Blog. Published on July 29, 2016. Accessed on November 13th 2024. Available at [https://emcrit.org/emcrit/awake-intubation-update/ ].
Financial Disclosures:
The course director, Dr. Scott D. Weingart MD FCCM, reports no relevant financial relationships with ineligible companies. This episode’s speaker(s) report no relevant financial relationships with ineligible companies unless listed above.
CME Review
Original Release: July 29, 2016
Date of Most Recent Review: Jul 1, 2024
Termination Date: Jul 1, 2027
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Thanks Scott Couldn’t agree more. We have become so comfortable with and perhaps lucky with our use of RSIs that the awake has been minimized as a relevant EM/CC procedure. The problem is that the awake is technically I believe somewhat more challenging than the RSI and we may choose what’s best for us not necessarily the patient (I’ve talked about this elsewhere as Hamlet’s Paradox: To be awake or To be asleep). We classically think of the awake as the option for the anatomically difficult airway but I probably do it more often now for the physiologically difficult airway.… Read more »
beautiful, my friend
Gentlemen, great topic as a CRNA that serves rural critical access hospitals this has been my go to technique for angioedema cases for years. This technique has been advocated and taught by Drs. Murphy and Huang at the difficult airway course for many years. Great technique!!
Thanks Dr. Kovacs and Scott for this Wee.. Will you guys teach us a little more on your thinking with regard to Laryngeal nerve block and transtracheal lidocaine for your Awake approach? The data on those techniques is quite longstanding and I don’t see a downside other than invasive nature. Also for those of us in the PHARM world we have limited space, limiting our resources. Will you teach us the precautions of using a nebulizer versus an atomizer with regard to lidocaine? From my practice Awake techniques are something I defer to a more multidisciplinary team generally involving at… Read more »
I am a GP working in a remote, rural community.
Why not just skip tropicalisation and simply use dissociative ketamine in all patients with a potentially difficult airway (unless the drug is contraindicated)? Given that all these patients end up needing some kind of post-intubation sedation anyway, it seems the simplest solution…
ketamine is not a free ride. some folks will stop breathing. in some the dissociation will worsen airway situation
Good to know. Thanks!
No access to the EZ atomiser at my institution…. any suggestions?
Nebulized lido instead? That takes a while to rig up. More MADgic?
yep, MADgic will get the job done
Curious – What formulation of topical lidocaine do you use for the ‘lollipop’? Are there options? Our pharmacist is struggling to find something approved for oral/tracheal use and looking for some literature/resources to point her to. Thanks from a little community hospital!
Do you think this might work using “Co-Phenylcaine”, our locally available high concentration lidocaine? It contains 5% lidocaine and 0.5% phenylephrine.
Great post. Could you tell me where your institution orders the atomizers from? The link no longer works and I cannot find a way to purchase from alcove medical. Thanks.