post-intubation management
DESCRIPTION
Post-Intubation ManagementTRANSCRIPT
Post Intubation Care in ED
J.Tembo 14 Aug 2014
Whew!
Check
• Tube is in correct position• Patient comfortable & as Physiologically
normal as possible• Aims for intubation achieved
Tube in correct position
• Continuous wave form EtCO2• Depth 22-24cm • Cuff pressure 20-30cm H20 use Cufflator
• Secured -tie unless raised ICP• CXR
Patient Safe• Protective lung ventilation• Raise head of bed 30-45 degrees• Sats• FiO2• Analgesia• Sedation• NGT• IDC• Eye care
Oxygenation & Ventilation
• Ventilator settings– Mode– TV– RR– FiO2
– PEEP– PS– I:E– Plt P
• Bloods gases
Watch out
• Tachypnoea• Tachycardia• Diaphoresis• Hypoxia• Tears
The Behavioral Pain Scale
Sedation,Analgesia,Paralysis
• M & M infusion• Propofol• Ketamine• Vecuronium– 0.1mg/kg– 0.06mg/kg/hr
Case 1
• M 33,previously well ,BIBA• 2hrs post Amitryptylline overdose >20mg/kg• GCS 14 and deteriorating• P 140 ,BP 90,Sats 96%• ECG= sinus tachycardia
Case 2
• F/65,lives alone, BIBA• COPD, still smokes, domiciliary O2
• Large pack of Meds + discharge summaries• Resp arrest at triage• Bag mask ventilation by Ambos• P66,Sats 72,BP
Case 3
Non Cardiogenic APO
End
References
• http://scghed.com/wp-content/uploads/2013/12/Emergency-Department-Post-Intubation-Checklist- accessed 12 Aug 14
• EMCrit Podcast 84-The Post Intubation Package-
• EMCrit Podcast 115-A new Paradigm for Post Intubation pain,Agitation and Delirium
• Basic Assessment &Support in Intensive Care