Q: LMA vs ETI

Hey guys,

Just a couple of more blogs before the SIM practice, and here is this week’s questions.

Case reminder: 24 yom Blair has global urticaria and SOB. The initial vitals were:

RR  32, HR 140, BP 80/50, GCS 14 (4,4,6), SPO2 80% on RA, bilateral wheeze

You are doing fantastic basic airway care. You’ve also decided to give adrenaline….but Blair further deteriorates;

RR 32, HR150, BP70/40, GCS 3, SPO2 89% on non-rebreather, stridor

Questions:

  1. What is your next step in terms of looking after airway & vent?
  2. What is the typical tidal volume of an adult?
  3. How often do you ventilate Blair?
  4. What factors influence the difficult ventilation via LMA? (Difficult LMA vent predictors)
  5. Would you ETI (call R50 if EMT or Para) Blair?
  6. Do you remember the difficult ETI predictors?

Look forward to hearing your response : )

Tatsu

 

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2 Comments Add yours

  1. This is from Mark P…

    Hi Tatsu….Difficult answer without seeing the patient, + ? central CAP & ? periferal CAP times.
    1) Airway and ventilation…
    Bag with peep. (passive) Nil ltd bag/vent pressure (tie on face seal with nasal prongs) self administer to start….See what happens….Bag if required….potential for aspiration post lunch….Bag with caution.
    2) Tidal volume…cant remember….Too long ago!
    3) refer to answer 1.
    4) LMA…seal problems, asperation problem, Be surprised if you could LMA a patient with a GCS of 14…Combative +++ Increasing agitation plus laryngeal spasm etc.
    5) definit R50 for airway issues…Potential RSI patient
    6) Not aware of ETI predictors….To long ago.

    Hopefully this chap has had a Adrenaline infusion ….If he has and he is still going down hill, he is probably either hypercarbic++ or sucked in some sea water as well. Could also be some CHF secondary to MI (unlikely)
    Ongoing allergic reaction, combined with an ? asthma event, osmotic pull from seawater in the lungs, could be half a dozen issues.

    Probably a quick trip to ED would be the best bet.
    Cheers Mark

    Like

    1. geehannah says:

      Further from Marks response:
      Tidal volume or inspiratory volume is ~500ml depending on what book you read
      predictors for difficult ETI uses the pneumonic LEMON
      •L. Look externally
      •E. Evaluate 3,3,2 rule
      •M. Mallamlati, view of the oropharangeal structures
      •O. Obstruction/Obesity
      •N. Neck mobility

      Liked by 1 person

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