Look Before You Leap - Awake Fiberoptic Intubation

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Look Before You Leap - Awake Fiberoptic Intubation

Look Before You Leap, Drive Your Ferrari Like it is a Wheelchair, Harken Ye to the Wicked Witch of the West!

A 37 year-old woman presents with stridor, drooling, tachypnea and accessory respiratory muscle use.  She has an adequate blood pressure, but is tachycardic to 120.  Her oxygen saturation on room air is a reassuring 97%.  She cannot answer questions, appears to have an altered mental status though she follows commands, and suddenly has a brief period of either myoclonus or seizure with unresponsiveness.  No post-ictal period is noted after this episode.

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Awake Fiberoptic Intubation

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Awake Fiberoptic Intubation

Like all procedures, success in the performance of an awake fiberoptic intubation comes from proper preparation.  Preparation for this procedure means so much more than proper preparation of the patient (preoxygenation, positioning, local anesthesia, etc.).  To be fully prepared is to have a well practiced, working knowledge of your equipment and the options you have in setting it up.  To be fully prepared is to be practiced in the motor skills necessary to drive the scope, advance the tube and troubleshoot as you go.

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The Decision to Intubate

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The Decision to Intubate

The I.C. Cordes College of Airway Knowledge, written by Dr. Steven Carleton, is known to many who have passed through our doors.  Today, however, we begin to set them free to the #FOAMed world starting off with I.C. Cordes #1 - The Decision to Intubate.  I felt like I had found a mint copy of the Amazing Fantasy Introducing Spiderman comic book or a Honus Wagner baseball card receiving these collected cases by email from Dr. Carleton earlier today. - Jeffery Hill, MD

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Trouble with Trachs - Recannulating the Stenosed Trach Site

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Trouble with Trachs - Recannulating the Stenosed Trach Site

TracheOTOMY sites can close up rapidly (within hours).  Why is this?  Essentially, there is (usually) no missing tissue with this procedure.  Occasionally the procedure does involve cutting a small section of the tracheal ring out but this is much less common now that percutaneous techniques are more in vogue  The percutaneous technique involves, essentially, dilation of the skin, soft tissue, and trachea and, as such, these sites can close up very rapidly.

TracheOSTOMYsites are less of of problem as they do involve the removal of tissue.  If they are fresh, however, these sites can also close relatively quickly.

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