Nerve Blocks Rule

Jon and I did this awesome ultrasound-guided superficial cervical plexus nerve block the other day for a R IJ central line placement– taught to us by none other than the amazing Dr. Otto Liebmann.

It was so neat we made a video about it. Check it out!

 

Of course the patient’s blue…that’s why I’m intubating.

 

Discussing: “Preoxygenation, Reoxygenation, and Delayed Sequence Intubation in the Emergency Department” (Weingart SD, J Emerg Med. 2010 Apr 7)

Main Points:

  1. Patients requiring intubation should be classified by oxygenation saturation as low risk, high risk and apneic.  
  2. Reservoir face masks with oxygen set at the highest rate possible are the recommended sources of high FiO2 during preoxygenation.  
  3. All patients, if possible, should be intubated with the head-elevated position to increase safe apnea time.
  4. Consider using CPAP masks, noninvasive positive pressure ventilation or PEEP valves on a bag-valve mask in patients who cannot achieve oxygen saturations greater than 93%-95%
  5. Rocuronium may provide a longer duration of a safe apneic period in patients with a high risk of desaturation.
  6. A nasal cannula set at 15 L/minute is effective at providing oxygenation during the apneic period.

Background:

Intubation is a vital procedure to the Emergency Physician.  Yet there is more to it than just placing an endotracheal tube.  There is the setup, positioning, oxygenation, sedation, checking tube placement, and more.  On top of this, there is the underlying illness to consider.  The truth is, the majority of patients intubated in the Emergency Department (ED) are sick.  Something is very physiologically wrong, and they are not maintaining adequate oxygenation.  It becomes your job to do this for them.  The authors in this article did an extensive literature review on pre-intubation and peri-intubation techniques which reduce the risk of hypoxia in the adult patient requiring intubation in the ED.   Continue reading