Experiment in Educational Topic Review

[RustedFox]

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Okay, I want to try this. We did this one or twice in residency, and it seemed like it got everyone involved and a lot was learned.

I'm going to start with a question. A broad one.
The next person (and the next in turn, and so on) answers using only *one* sentence, leaving room for more and more one-sentence details to expound on the topic until we think we've got all the salient points, or until another question (ideally about the same topic) is posed. Or, since this is SDN - the thread gets derailed and someone compares someone else to a Nazi.

Ready? Our critical care folks should dig this one.

"When is intubation a BAD idea?"

 

[thegenius]

Greater than or equal to 85 years old.

 

[Apollyon]

Asthmatic pt

 

[bravotwozero]

DKA, but sometimes you don’t have a choice I suppose.

 

[Tenk]

When you forgot to check the blood glucose first.

 

[dadaddadaBATMAN]

Okay, I want to try this. We did this one or twice in residency, and it seemed like it got everyone involved and a lot was learned.

I'm going to start with a question. A broad one.
The next person (and the next in turn, and so on) answers using only *one* sentence, leaving room for more and more one-sentence details to expound on the topic until we think we've got all the salient points, or until another question (ideally about the same topic) is posed. Or, since this is SDN - the thread gets derailed and someone compares someone else to a Nazi.

Ready? Our critical care folks should dig this one.

"When is intubation a BAD idea?"

When you have made no effort at positioning or preoxygenation

 

[dadaddadaBATMAN]

Okay, I want to try this. We did this one or twice in residency, and it seemed like it got everyone involved and a lot was learned.

I'm going to start with a question. A broad one.
The next person (and the next in turn, and so on) answers using only *one* sentence, leaving room for more and more one-sentence details to expound on the topic until we think we've got all the salient points, or until another question (ideally about the same topic) is posed. Or, since this is SDN - the thread gets derailed and someone compares someone else to a Nazi.

Ready? Our critical care folks should dig this one.

"When is intubation a BAD idea?"

Salicylate toxicity.

Maybe more the spirit of what you’re going for.

 

[WilcoWorld]

Before you check for advanced directives.

 

[WilcoWorld]

When you have a severely hypotensive trauma patient who has an intact airway and you haven't yet treated the tension pneumothorax.

 

[dadaddadaBATMAN]

When you have a severely hypotensive trauma patient who has an intact airway and you haven't yet treated the tension pneumothorax.

You had me at severely hypotension trauma pt with intact airway

 

[dadaddadaBATMAN]

DKA, but sometimes you don’t have a choice I suppose.

I hate these. They are probably my least favorite physiologically difficult airway.

It's like a coroncopia of **** you don't want to intubate

1. severe acidosis
2. Good respiratory compensation naturally that you can't match
3. serous hyperkalemia (Despite whole body hypo) which will worsen with acidosis while you are tubing
4. hard to manage adequate ventilation after
5. might puke or already did but so dry you see aspiration later
6. +/- hypotension


My threshold is usually either such profound coma I don't have a choice, or when they start getting a combined respiratory acidosis (as in they are failing)

 

[pkwraith]

Laryngectomy patient

 

[wareagle726]

GCS 8(+/- 2) witnessed seizure post-octal

 

[GeneralVeers]

Pseudoseizure that is dilaudid responsive.....nevermind intubation is a good idea.

 

[CoolDoc1729]

Intubation has been known to cure pseudo seizures lol

 

[elanmorin]

When your patient is Justin Bieber

 

[Mount Asclepius]

If you can’t recognize an esophageal intubation in a patient that you give a paralytic.

 

[Mount Asclepius]

When is intubation a good idea?

Burn patient with inhalational smoke injury and muffled speech worsening despite treatment prior to flight transfer to burn center.