Since you studs already have been through the EEACC once, you now have to step it up an notch and go through some post-intubation care with Nick. You guys will skip the Paeds and Cric stations (since you are obviously masters of these skills) and will instead go through the Post-Intubation station.
Schedule to follow...
The Post intubation care package:
From Life in the Fast Lane: (http://lifeinthefastlane.com/education/ccc/post-intubation-care/)
- key steps in patient care following intubation
- Waveform Capnography
- Secure the Tube Well
- Confirm Lung Protective Vent Settings
- Achieve Adequate Analgesia and Sedation
- Raise the Head of the Bed to 30 – 45°
- Humidify the Air
- Place In-Line Suction
- Gastric Tube
- Cuff Pressure
- Prevent Aspiration past the Cuff of the ETT
- Get a Blood Gas
- Check Tube Depth
- Put a BVM at the Bedside ± PEEP Valve
- Have a Plan for Vent Alarms
- Stress Ulcer and DVT Prophylaxis
- Oral Decontamination
Podcast 84 – The Post-Intubation Package
The Post-Intubation Package
There is a ton of stuff to do post-intubation besides confirming the tube and giving the team high-fives. What we do in the ED has ramifications on the patient’s course in the hospital. Preventing badness starts with us.
Achieve Adequate Analgesia and Sedation
I won’t belabor this, because I’ve discussed it in so many other podcasts, such as the one about not leaving your patient in a nightmare
FAST HUGS IN BED Please!
Regardless of the underlying cause of the illness, the provision of meticulous supportive care is essential to the management of any critically ill patient. Back in 2005, Jean Louis Vincent popularised the FAST HUGS mnemonic for recalling the key issues to review when looking after a critically ill patient.
- Head up position
- Ulcer prophylaxis
- Glycemic control
- Spontaneous breathing trial
Post intubation sedation/analgesia/paralysis
EMCrit Podcast 21 – A Bad Sedation Package Leaves your Patient Trapped in a Nightmare
Pushing some ativan followed by vecuronium is no longer an acceptable strategy to manage post-intubation sedation. A good analgesia and sedation package is essential if you care about your patient’s comfort and well-being. We need to move to PAIN-FIRST paradigm. Optimize analgesia and then add in sedative agents as a bonus. In this episode of the EMCrit Podcast, I expand on a previous rant to discuss the optimal way to handle routine post-intubation patients and some special scenarios you may encounter.
“A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomized trial” Lancet.2010 Feb 6;3759(9713):475-80.