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Message: <blockquote data-quote="FFP" data-source="post: 22367936" data-attributes="member: 171991">Things to remember:1. There is no skeletal muscle contracture that cannot be resolved by a muscle relaxant, especially in intubating doses.2. Most, if not all, patients are much easier to BOTH ventilate AND intubate if they have muscle relaxant on board. Many difficult intubations are due to positioning and not enough muscle relaxation.3. Always have a backup plan to the backup plan, and maybe even to that.Ask yourself:What would you have done if, as expected by you, you couldn't have opened her mouth AT ALL, and she stopped breathing after your propofol (and you only have a nare to ventilate her through and maintain pCO2/pO2)? If this patient truly would have been a Cannot Ventilate, Cannot Intubate situation, as expected?What would you have done if this patient vomited or coughed during your DL, or decreased her CPP for some other reason (hypoventilation, hypotension) and had a Cushing reflex/coded?Next time, before you do a DL in an unparalyzed almost unconscious patient, fentanyl (or another short-acting opiate) may be more helpful instead of propofol (assuming you have naloxone) to inhibit those airway reflexes and decrease stimulation. Why? Because it can be easily reversed with naloxone, getting the patient back to spontaneous ventilation (not so easy if one overshoots with late-acting propofol).</blockquote>

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