Tamingthesru
Favorite Positions!
Multiple casualties are brought to you from a house fire. There are four victims:
- A 5’11” 70 kg woman with a GCS of 8
- A 5’9” 140 kg man with circumferential burns of the chest and neck
- A 20 month-old with a pedi-GCS of 10
- An elderly, 5’6” 65 kg man with no burns, but a history of severe CHF and complaining of chest pain and dyspnea
You determine that they all require intubation for various indications. You choose RSI as the method for all except the morbidly obese patient, who you intend to intubate awake, with sedation and topical airway anesthesia.
Question:
How would you position each of these patients to optimize your chances of successful intubation on the first attempt?
Global Health Case Files
Imagine: you are the single provider manning a rural clinic in Northern Tanzania along the shore of Lake Victoria. You are one of only a handful of physicians in the entire region and you have minimal access to diagnostics or therapeutics. Your clinic does not have any power. Your diagnostics include: urinalysis, urine pregnancy, CBC and rapid tests for HIV, syphilis, and malaria. You have 2 nurses, one of whom acts as a translator (from Swahili to English). You are armed primarily with your intellect, knowledge of local disease processes, and your keen sense of intuition.
Endotracheal Intubation vs. Supraglottic Airway Placement for Out-of-Hospital Cardiac Arrest
If you want to get a group of prehospital providers riled up, simply ask them how the airway should be managed during out-of-hospital cardiac arrest. "Supraglottic airways are easier!" "No, you gotta stay with endotracheal intubation!" "Forget advanced airways, a bag-valve mask is all you need!" "Only apneic oxygenation!" Don't believe me?