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- Jun 3, 2009
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I'm a CA-1 and when on call I carry the pager for all floor intubations. I've asked my upper class residents their strategy for floor intubations and it seems that I've had as many opinions as there are residents at my program. There appears to be two schools of thought on how to approach them.
1. Everyone gets either Propofol or Etomidate and Sux so long as there is no contraindication. If there is a contraindication then the pt will get Roc. This gives the resident the best possible chance at getting the intubation. This group seems to be the minority at my institution.
2. The other school of thought never paralyzes anyone ever. They mix Etomidate and Propofol for each pt. Or if the pt's BP can tolerate it, then Propofol only. The Propofol is used with the Etomidate to try to relax airway reflexes enough to have a decent view at intubation. This group also seems to like baby doses of Propofol. Far less then we ever use in the OR during induction
I had my first solo intubation in the unit the other day. I tried the conservative approach and used only Propofol. I had a fairly poor view of the cords and they wouldn't open completely. The pt desated quick. I had to bag her for a while and then ended up using Etomidate and Sux which made for an easy tube.
Any thoughts from experienced residents and attendings would be great. Also would like to know relative doses of Propofol and NMBs used. Floor intubations are by far the most stressful aspect of my residency right now and so I'd really appreciate the input of experienced docs. Thanks.
1. Everyone gets either Propofol or Etomidate and Sux so long as there is no contraindication. If there is a contraindication then the pt will get Roc. This gives the resident the best possible chance at getting the intubation. This group seems to be the minority at my institution.
2. The other school of thought never paralyzes anyone ever. They mix Etomidate and Propofol for each pt. Or if the pt's BP can tolerate it, then Propofol only. The Propofol is used with the Etomidate to try to relax airway reflexes enough to have a decent view at intubation. This group also seems to like baby doses of Propofol. Far less then we ever use in the OR during induction
I had my first solo intubation in the unit the other day. I tried the conservative approach and used only Propofol. I had a fairly poor view of the cords and they wouldn't open completely. The pt desated quick. I had to bag her for a while and then ended up using Etomidate and Sux which made for an easy tube.
Any thoughts from experienced residents and attendings would be great. Also would like to know relative doses of Propofol and NMBs used. Floor intubations are by far the most stressful aspect of my residency right now and so I'd really appreciate the input of experienced docs. Thanks.