Case of the week 14

Time- 0200

A 51-year-old male with a history of diabetes and hypertension presented to the hospital with left facial droop, slurred speech, and left-sided hemiparesis. His initial CT scan was negative for acute hemorrhage. As he has no contraindication for thrombolysis the stroke team decided to treat him with tPA.

After the infusion finished patient developed left-sided facial swelling.

  • How will you approach this situation initially?

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Bite-Sized Basics: Urgent Endotracheal Intubation

The Urgent Endotracheal Intubation (UEI) describes the primary intubation scenario that occurs in the ED where intubation must proceed in a semi-rapid or rapid fashion due to the patient’s clinical state.

We discuss the Rapid Sequence Intubation, the mainstay of the UEI with the longest history and firmest evidence base.

In Beyond the Basics we look at alternatives to RSI including:

– Modified RSI

– Rapid Sequence Airway (RSA)

– Delayed Sequence Intubation (DSI)

– Awake Intubation

– Inevitable Surgical Airway

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Bite-Sized Basics: Apnoeic Oxygenation

We take a look at the relatively new airway management technique of Apnoeic Oxygenation, explaining

– what it is and how we perform it

– how it works

– what’s the evidence

– when we should use it

and include some techniques that are BEYOND THE BASICS.

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Bite-Sized Basics: Preoxygenation

This is our very first Bite-Sized Basics post and the topic is Preoxygenation.

Preoxygenation (PreOx) is a critical step performed prior to intubation or sedation to extend the period of safe apnoea. We take a look at:

– how best to perform it and the choice of Preox devices in the ED

– what to do when we run into problems achieving PreOx

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