However, laryngospasm that is unresponsive to airway maneuvers and propofol is rare and using paralytics without intubating is unheard of in the emergency department. In anesthesia, this traditionally involves giving a low dose of succinylcholine to break the spasm. If there is no response to deepening anesthesia, the next step is an IV paralytic. Propofol is the traditional agent, at a dose of 0.5mg/kg IV push. If the oxygen saturation allows, start by deepening anesthesia. Key question: Is there desaturation? For the patient with already low oxygen saturation, proceeding immediately to paralysis and intubation is reasonable. A nurse is asked to draw up a paralytic (either succinylcholine 1.5mg/kg or rocuronium 1.2mg/kg). While providing CPAP and applying pressure to Larson’s point, I ask my RT to prepare my intubation equipment for a potentially difficult airway. Using a bag valve mask with a PEEP valve and 100% oxygen, provide continuous positive airway pressure.Apply a modified jaw thrust maneuver, where the pressure is applied near the top of the ramus of the mandible in the “laryngospasm notch” aka “Larson’s point”.The key to reversal is application of CPAP with good basic airway maneuvers. A quick glance at the monitor shows a flat CO2 tracing. You glance at the patient and recognize significant respiratory muscle contraction and stridor. Just as you are about to entertain the room with your latest cheesy joke, you hear a loud squeaking. After moving to an appropriate room, going through the pre-sedation checklists, and tracking down all the folks that are required to be present, you give a dose of ketamine. You hear these polite refusals from across the department and wander over to offer your help with a procedural sedation. This is an updated version of the first ever post on CaseĪ feisty 3 year old tripped, cut her lip, and is now politely refusing your colleague’s attempts at suturing. I never imagined that so many people would be interested in my emergency medicine education project. Thank you to everyone who has helped me a long the way, and especially to everyone who has spent their time reading this blog. It has now been a full year since I started First10EM.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |