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Awake
Intuba
tion
When is this a good idea?
Apneic
RSI Awake
Crash
Tough
YesNo
Yes
No
Apneic
RSI Awake
Crash
Tough
YesNo
Yes
No
Why is this a good idea?
Cases
Awake Intubation the EMCrit Way
Awake Intubation the EMCrit Way
Awake Intubation the EMCrit Way
Awake Intubation the EMCrit Way
Awake Intubation the EMCrit Way
Awake Intubation the EMCrit Way
Awake Intubation the EMCrit Way
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
·
Awake Intubation the EMCrit Way
Dry ‘em Out
Suction and Pad Dry
My Residents
Awake Intubation the EMCrit Way
Topicalize
Awake Intubation the EMCrit Way
Awake Intubation the EMCrit Way
5 ml of 4% Lidocaine nebulized
@ 5 LPM
Awake Intubation the EMCrit Way
My resident, Raghu,
was teased for months for
that last suctioning
Sorry, Raghu!
Spray the back of the oropharynx if
necessary
Awake Intubation the EMCrit Way
I should have
smurfed the
methylene
blue!
Awake Intubation the EMCrit Way
Mucosal
Atomization
Device
Awake Intubation the EMCrit Way
Lido Lollipop
Awake Intubation the EMCrit Way
Awake Intubation the EMCrit Way
Consider anesthetizing below the cords
Awake Intubation the EMCrit Way
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)
Awake Intubation the EMCrit Way
Preoxygenate
Nasal Cannula
Optimally Position
the Patient
Optimally Position the
Patient
R. Levitan
Awake Intubation the EMCrit Way
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
Awake Intubation the EMCrit Way
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
Awake Intubation the EMCrit Way
Awake Intubation the EMCrit Way
Rudy Malmquist
Have a
Backup Plan
and a
Failure Plan
Backup Plan
Retrograde
Intubation
Failure Plan
RSI
LMA
Cric
Awake Intubation the EMCrit Way
Post-Tube
Care
Awake Intubation the EMCrit Way
To Review
Awake Intubation the EMCrit Way
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!
Awake Intubation the EMCrit Way
Awake Intubation the EMCrit Way

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