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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
Yes No
Yes
No
Apneic
RSI Awake
Crash
Tough
Yes No
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!
