Big Medicine In a Bad Airway Way (Limitations in K.S.I. and Limitations of V.L.)
Can you imagine a case when a patient's daughter tells you that the patient has been desating to the low 80% for past 3 weeks while on bipap on home. She has more than copd but Morbid Obesity is not mentioned as her medical problems. Luckily my eyes work well with my glasses.
Worse is that the patient is chronically debilitated from her COPD that she is chronically on po steroids and gets bigger and bigger in size as per the daughter. Pt doesn't exercise/walk. Pt is in a poor metabolic state.
ABGs kept getting worse on this patient. Intubation was inevitable. The daughter wanted everything done and the patient deferred to the daughter's wishes and desires. I couldn't believe it.
This lady will one day buy herself a tracheostomy and become ventilator dependent the rest of her life.
Teaching Point #1.
The Backup for Video Laryngoscopy is Direct Laryngoscopy a.k.a. Cold Steel.
When the V.L. is not working or broken or missing, you have to be good at this soon to be relic of 20th century design.
Always have a Direct Laryngoscopy blade as a backup when using a Video Laryngoscopy blade.
Always have a Video Laryngoscopy blade as a backup when using a Direct Laryngoscopy blade.
Teaching Point #2.
Video Laryngoscopy only as valuable as the presence of working batteries.
Have your Batteries ready to replace the ones that die on your when you need them the most.
Teaching Point #3.
When you use Ketamine Sequence Induction for airway management, the protective airway reflexes are still present like gagging and laryngospasm.
Ketamine maintains sometimes unwanted protective airway reflexes when you least expect it. To the point the patient can get laryngospasm.
the Treatment of laryngospasm is the human vulcan pinch of the area behind the ear over the mastoid causing a very painful noxious stimuli.
or Paralyze the patient. Have the Sux or Roc or Vec ready.