Post Intubation Care in ED

J.Tembo 14 Aug 2014

Whew!

Check

• Tube is in correct position• Patient comfortable & as Physiologically

normal as possible• Aims for intubation achieved

Tube in correct position

• Continuous wave form EtCO2• Depth 22-24cm • Cuff pressure 20-30cm H20 use Cufflator

• Secured -tie unless raised ICP• CXR

Patient Safe• Protective lung ventilation• Raise head of bed 30-45 degrees• Sats• FiO2• Analgesia• Sedation• NGT• IDC• Eye care

Oxygenation & Ventilation

• Ventilator settings– Mode– TV– RR– FiO2

– PEEP– PS– I:E– Plt P

• Bloods gases

Watch out

• Tachypnoea• Tachycardia• Diaphoresis• Hypoxia• Tears

The Behavioral Pain Scale

Sedation,Analgesia,Paralysis

• M & M infusion• Propofol• Ketamine• Vecuronium– 0.1mg/kg– 0.06mg/kg/hr

Case 1

• M 33,previously well ,BIBA• 2hrs post Amitryptylline overdose >20mg/kg• GCS 14 and deteriorating• P 140 ,BP 90,Sats 96%• ECG= sinus tachycardia

Case 2

• F/65,lives alone, BIBA• COPD, still smokes, domiciliary O2

• Large pack of Meds + discharge summaries• Resp arrest at triage• Bag mask ventilation by Ambos• P66,Sats 72,BP

Case 3

Non Cardiogenic APO

End

References

• http://scghed.com/wp-content/uploads/2013/12/Emergency-Department-Post-Intubation-Checklist- accessed 12 Aug 14

• EMCrit Podcast 84-The Post Intubation Package-

• EMCrit Podcast 115-A new Paradigm for Post Intubation pain,Agitation and Delirium

• Basic Assessment &Support in Intensive Care