Sometimes we have to go back to the basics. Airway management has its many advanced methods but with all the great FOAMed out there, very little of it covers the basic approach. We wish to remedy this with guest Kris Maday, PA-C. He is another PA with a podcast. His is called the PAINE Podcast and can be found here.
As discussed in the podcast, you need to know the 7 P's of intubation:
Preparation - A checklist such as the one from EmCrit would be beneficial. There are also dump kits that are available in most departments. The key is to make sure you have a systematic approach.
Position - Ramping a position will allow for better airway management as specified in this paper. Both Scott Weingart and Rich Levitan speak of this frequently.
Preoxygenate - We know that increasing the oxygen saturations and getting the nitrogen out is key, but techniques such as apneic oxygenation is beneficial once it is time to intubate.
Premedicate - Knowing the right medications is vitally important. As noted at the top, there are many medications and essentially all are weight based. Knows the risks, benefits, and potential side effects of each of these medications in detail.
Paralysis - After sedation comes paralysis. Do NOT paralyze first! Again, choose the medications wisely.
Pass the Tube - There is a huge debate about whether video laryngoscopy (VL) or direct laryngoscopy (DL) is better but it really does not matter as long as you learn and get good at both. Training is key with all of this but learning how to pass the tube safely will save a patient's life. Remember, if this fails then it comes down to the surgical airway.
Post-intubation Assessment - End tidal CO2 is vital for confirmation and with it ultrasound is becoming a great asset. Traditionally this also includes a chest x-ray and a good physical exam with listening to lung sounds. Listen to the podcast on why this may not be as beneficial as you may think.
If you do not already have a favorite, get a checklist like the one above. Also, remember to stop by and see Kris Maday's PAINE Podcast as seen here. He does a lot of hard work in educating PA students. It has been a pleasure working with him and will be happy to have him back on the podcast. Kris will also be posting the same podcast to his website.
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