EMCrit Podcast Podcast 129 – LAMW: The Neurocritical Care Intubation
13 snips
Jul 26, 2014 Exploring the challenges of intubating neurologically critical patients with elevated intracranial pressure, highlighting the importance of precise technique. Strategies for preventing adverse outcomes in traumatic brain injury, aortic dissection, and subarachnoid bleed. Utilizing fentanyl, esmolol, nicardipine, and hypertonic saline to manage blood pressure spikes and intracranial pressure. Benefits of propofol and ketamine mix for stable neurocritical care intubation, emphasizing hemodynamic stability and cerebral metabolic rate reduction.
AI Snips
Chapters
Transcript
Episode notes
Choose Semi‑Elective Cases Only
- Do only semi-elective neuro intubations when you have time to prepare and the patient is breathing but deteriorating.
- Avoid this approach in crash intubations or hypotensive TBI patients who need immediate tube and blood pressure support.
Preoxygenate And Monitor EtCO2
- Preoxygenate aggressively with nasal cannula plus non‑rebreather at 15 L/min for at least three minutes.
- Attach and use end‑tidal CO2 during preoxygenation so you can monitor ventilation right after intubation.
Use Gentle Video Laryngoscopy
- Limit laryngoscopy force and attempts to reduce sympathetic spikes; use the best intubator available.
- Prefer video laryngoscopy to minimize lifting pressure and blunt sympathetic response if you are experienced with it.