Volatile - you wanted proof.

[militarymd]

---

Members don't see this ad.

Question for you guys. I was at a code recently where pt was given etomidate and for the life of me i could not open her mouth- luckily attending was present and she was a fairly easy bag, so we gave succ, which she responded well to. How often does this hapen and are there any ways around it without paralytics

time,
more sedation,
more hypoxia,
more sux,

many ways around it.

 

[Tenesma]

the interesting thing about etomidate... it only really starts working until you either give propofol or sux 😀

 

[TheSandMan]

time,
more sedation,
more hypoxia,
more sux,

many ways around it.

thanks for the reply mil. so basically what u are saying is that she was too light

 

[johankriek]

Pretty bold.

I've been in private practice ten years....and yeah, I occasionally give an intermediate-neuromuscular blocker for an out-of-the-OR intubation....but not very often. I certainly wouldnt order this as an intern.

I'd venture to say that until you know in your heart you can intubate a fire-ant, I wouldnt give any paralysis.

Once prowess is reached, though, I humbly disagree with most posting here.

If acceptable, 40 mg sux is the way to go. Gives you a (brief) window of optimal intubating conditions. But again, the prerequisite is that you can intubate a fire-ant.

rule of thumb; note to residents

dont give anything to patients who you are intubating on the floor.. DO IT AWAKE.. period.. if you have time.. spray em down..

if you have to go around the rule of thumb..... give a benzo to help you out.. if they need succ. they are not that bad off

Hypoxia is the best relaxant

 

[underdog27]

rule of thumb; note to residents

dont give anything to patients who you are intubating on the floor.. DO IT AWAKE.. period.. if you have time.. spray em down..

if you have to go around the rule of thumb..... give a benzo to help you out.. if they need succ. they are not that bad off

Hypoxia is the best relaxant

That is funny you mention that. While doing my pediatrics rotation, I worked with a VERY experienced attending that swore by this. He stated he could not remember that last time he gave sux for a laryngospasm, he would just break them with positive pressure. If that did not work, he said once they became hypoxic their cords would relax.

 

[Noyac]

I almost always give relaxants outside the OR along with versed usually, propofol sometimes and yes even etomidate if the I feel like it.

Can I intubate a fire-ant?

I don't know.

I never tried.

 

[Beck928]

Well, I see what you guys are saying about the paralytics...in the particular case where I was told that the cords were tight, I just thought it might be better than no paralytics. But there's more than one way to skin a cat, I guess. I appreciate the input from all the experts!

 

[jetproppilot]

I almost always give relaxants outside the OR along with versed usually, propofol sometimes and yes even etomidate if the I feel like it.

Can I intubate a fire-ant?

I don't know.

I never tried.

If you can play for the New York Mets before an anesthesia career, Noy, I don't see intubating a fire-ant to be a problem for you.

I'll start the IV while you slip in the .00025 ETT. 👍

 

[Noyac]

Now about nurses making it hard on interns and residents. Refusing orders, giving lip. Just remember, when you are gone and off in your new job outside of residency, they will still be there. They will be making it hard on some new inter but they are still there. It doesn't make it right but it is redeeming never the less.

And if you prove yourself, they will leave you alone and respect you. Don't be an arse about it, that never helps. Just be confident and kind, yes kindness still goes a long way. They like giving **** to a88hole residents but the joy just isn't there when you are the nice one.

It all ends, usually in residency but definitely in practice.

If they continue to do this in private practice then they can be dealt with better. Bt it just doesn't happen as often as far as I can tell.

 

[Noyac]

If you can play for the New York Mets before an anesthesia career, Noy, I don't see intubating a fire-ant to be a problem for you.

I'll start the IV while you slip in the .00025 ETT. 👍

Deal

I'd much rather try to intubate than to start that IV.

By the way, Baseball was easy. See the ball, hit the ball, catch the ball. That's it.

 

[jetproppilot]

Deal

I'd much rather try to intubate than to start that IV.

By the way, Baseball was easy. See the ball, hit the ball, catch the ball. That's it.

Yeah, OK dude.

Can't compete with that.

You da man. A humble rokkstar. 👍

 

[The_Sensei]

by the way i don't care how many years of private practice you have...

Good for you 🙄

 

[dhb]

Funny how there never seems to be a consensus 🙂 , so to summarize: if you need to intubate on the floor first try with minimal sedation if unsuccesfull (tight cords) and some sux right?

 

[GasEmDee]

Funny how there never seems to be a consensus 🙂 , so to summarize: if you need to intubate on the floor first try with minimal sedation if unsuccesfull (tight cords) and some sux right?

That is too simple. Some important details are being left out. For example, why does the patient need to be intubated. Is it emergent, or do you have a bit of time? How awake is the patient? If it is truly emergent, just quickly get the tube in. If the patient is altered, there may be no need for sedation/induction. In other scenarios, sedation/induction/relxation may or may not be indicated. Your plan will depend on the specific scenario you are facing.

 

[VolatileAgent]

I'll start the IV while you slip in the .00025 ETT. 👍

what size laryngoscope blade do you use for that? miller 00000000000000?

 

[dhb]

If the patient is altered, there may be no need for sedation/induction.

I know it was a simplistic view and of course if the patient has a Glascow score of 4 you don't really need to sedate him further 😉