This week we dive into some advanced topics in RSI including patient positioning and pre-intubation resuscitation.
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Benefits of Bed-Up Head Elevated Position
- Use the bed-up head elevated (BUHE) position by raising the head of the bed about 30 degrees during pre-oxygenation and intubation.
- This position improves pre-oxygenation, extends non-hypoxic apnea time, and may enhance laryngoscopic view, reducing complications.
Pre-Intubation Resuscitation Tips
- Resuscitate patients at risk of hypotension aggressively before intubation with fluids and liberal use of vasopressors.
- Use nasal cannula plus face mask or non-invasive positive pressure ventilation to maximize oxygenation and maintain blood pressure around a MAP of 70.
Choose Epinephrine Over Phenylephrine
- Prefer epinephrine over phenylephrine for pressor support in hypotensive intubations.
- Epinephrine increases both vascular resistance and cardiac output, benefiting shocky patients more than pure alpha agonists like phenylephrine.
