Moderator EMEDPA Posted August 12, 2016 Moderator Share Posted August 12, 2016 Just intubated a 300 lb pt (mallampati 4) with pneumonia in resp failure who failed bipap. yes, used a glidescope. anyway, tube in good position, end tidal c02 good, sats fine, chest film confirms placement. pt requiring high pressures to ventilate despite vecuronium and frequent suctioning. added 100 mg of ketamine with great effect. RT was able to turn down peep and 02 concentration and maintain sats. I love this drug. this may be the most challenging intubation I have ever done without anesthesia in the room. intubated a big guy with huge teeth, no neck or chin recently in the OR, but that was not a high-stress crashing pt situation like this. Link to comment Share on other sites More sharing options...
RuralER/Ortho Posted August 12, 2016 Share Posted August 12, 2016 Strong work! Link to comment Share on other sites More sharing options...
EMSGuy1982 Posted August 12, 2016 Share Posted August 12, 2016 Awesome job! Sounded like a tough one for sure. Maybe that's why they call it "special K" :-) I sure don't miss dropping tubes pre-hospital in living rooms full of trash. My old partner I used to work with told me that everyone in the county has switched to ketamine from ativan. I used ketamine for conscious sedation to put in a heimlich chest tube for a pneumo during my ER rotation and it worked wonders.. I admit it was a little disturbing when I got the "ketamine stare" my preceptor warned me about.. Link to comment Share on other sites More sharing options...
jmj11 Posted August 12, 2016 Share Posted August 12, 2016 You do the PA profession proud (not from just this event but from your life). Link to comment Share on other sites More sharing options...
fishbum Posted August 12, 2016 Share Posted August 12, 2016 It's pretty awesome for induction in hypotensive patients, too. Little bit of bronchospasm and/or hypotension=ketamine for the win. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 12, 2016 Author Moderator Share Posted August 12, 2016 You do the PA profession proud (not from just this event but from your life). RIGHT BACK AT YOU MY FRIEND. You are a groundbreaking PA on many levels... Link to comment Share on other sites More sharing options...
DolphinsPA2 Posted August 25, 2016 Share Posted August 25, 2016 Sweet! Just an FYI though....chest x-rays don't confirm placement of ET tubes Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 25, 2016 Author Moderator Share Posted August 25, 2016 Sweet! Just an FYI though....chest x-rays don't confirm placement of ET tubes SURE, seeing it go through the cords, no epigastric sounds, b/l breath sounds,end tidal c02, etc does, but "ideal" placement is generally based on where the radiologist says your tube is ; "it needs to come up 0.5 cm", etc). Link to comment Share on other sites More sharing options...
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