Case #7-1: Rapid Sequence Intubation (RSI) for Rookies and Reviewers

A 39M is BIBA, boarded and colored, with altered mental status.  He was found down at the bottom of a flight of stairs.  130/75, 92, 14, 99%, afebrile, GCS 12 (3 Eyes, Verbal 4, Motor 5), no focal neuro deficits.  He has a hematoma on his forehead.  All of a sudden, during your secondary survey, he sits up in bed and becomes combative but purposeless.  He's easily restrained with haldol.  Now what?

Web 2.0 Resources Used:
Life in the Fast Lane
EM Basic
Penultimate
EM Lyceum

I'm an intern, and have recently begun transition shifts in which I get first shot at all department intubations.  In order to handle situations like the one above, I needed to be prepared.

How did I prepare?

Chris Nickson recently updated his Own the Airway! tutorial on Life in the Fast Lane.  This is an amazing resource which teaches airway management by organizing free videos borrowed from other sites.  The format is very user friendly.

But, the LITFL resource is missing a key element in RSI - the drugs!

Steve Carroll's straightforward and useful EM Basic podcast on airway management served as a good introduction.  Before listening to the podcast, I took screenshots on my iPad of the shownotes, and pasted the pictures into a Penultimate notebook.  I wrote my own notes on top of the shownotes while I listened.


To learn more about RSI drugs, I read the EM Lyceum posts on RSI pharmacology.  EM Lyceum links you to the primary literature to be able to intelligently form opinions on controversial topics yourself.

EM Lyceum
I realized quickly that every Web 2.o resource above referenced the clasic text, Walls' Emergency Airway Management.  I ordered it from amazon, and read it cover to cover. 

"The patient might have a head bleed, he needs to be intubated, but we don't want to raise his ICP," I said.  We'll use a weight of about 80kgs: give him 120mg of lidocaine and 250mcg of fentanyl .  Then push 25mg of etomidate, and 120mg of sux, in that order," I said confidently. 

I intubated him, gave him another 50mcg of fentanyl and started him on a 2mg/min propofol drip.  He was then rushed off to CT.

- Case 7-2 will discuss rapidly accessible bedside RSI resources for your phone or tablet

Case #7-1: Rapid Sequence Intubation (RSI) for Rookies and Reviewers

A 39M is BIBA, boarded and colored, with altered mental status.  He was found down at the bottom of a flight of stairs.  130/75, 92, 14, 99%, afebrile, GCS 12 (3 Eyes, Verbal 4, Motor 5), no focal neuro deficits.  He has a hematoma on his forehead.  All of a sudden, during your secondary survey, he sits up in bed and becomes combative but purposeless.  He's easily restrained with haldol.  Now what?

Web 2.0 Resources Used:
Life in the Fast Lane
EM Basic
Penultimate
EM Lyceum

I'm an intern, and have recently begun transition shifts in which I get first shot at all department intubations.  In order to handle situations like the one above, I needed to be prepared.

How did I prepare?

Chris Nickson recently updated his Own the Airway! tutorial on Life in the Fast Lane.  This is an amazing resource which teaches airway management by organizing free videos borrowed from other sites.  The format is very user friendly.

But, the LITFL resource is missing a key element in RSI - the drugs!

Steve Carroll's straightforward and useful EM Basic podcast on airway management served as a good introduction.  Before listening to the podcast, I took screenshots on my iPad of the shownotes, and pasted the pictures into a Penultimate notebook.  I wrote my own notes on top of the shownotes while I listened.


To learn more about RSI drugs, I read the EM Lyceum posts on RSI pharmacology.  EM Lyceum links you to the primary literature to be able to intelligently form opinions on controversial topics yourself.

EM Lyceum
I realized quickly that every Web 2.o resource above referenced the clasic text, Walls' Emergency Airway Management.  I ordered it from amazon, and read it cover to cover. 

"The patient might have a head bleed, he needs to be intubated, but we don't want to raise his ICP," I said.  We'll use a weight of about 80kgs: give him 120mg of lidocaine and 250mcg of fentanyl .  Then push 25mg of etomidate, and 120mg of sux, in that order," I said confidently. 

I intubated him, gave him another 50mcg of fentanyl and started him on a 2mg/min propofol drip.  He was then rushed off to CT.

- Case 7-2 will discuss rapidly accessible bedside RSI resources for your phone or tablet

Case #7-1: Rapid Sequence Intubation (RSI) for Rookies and Reviewers

A 39M is BIBA, boarded and colored, with altered mental status.  He was found down at the bottom of a flight of stairs.  130/75, 92, 14, 99%, afebrile, GCS 12 (3 Eyes, Verbal 4, Motor 5), no focal neuro deficits.  He has a hematoma on his forehead.  All of a sudden, during your secondary survey, he sits up in bed and becomes combative but purposeless.  He's easily restrained with haldol.  Now what?

Web 2.0 Resources Used:
Life in the Fast Lane
EM Basic
Penultimate
EM Lyceum

I'm an intern, and have recently begun transition shifts in which I get first shot at all department intubations.  In order to handle situations like the one above, I needed to be prepared.

How did I prepare?

Chris Nickson recently updated his Own the Airway! tutorial on Life in the Fast Lane.  This is an amazing resource which teaches airway management by organizing free videos borrowed from other sites.  The format is very user friendly.

But, the LITFL resource is missing a key element in RSI - the drugs!

Steve Carroll's straightforward and useful EM Basic podcast on airway management served as a good introduction.  Before listening to the podcast, I took screenshots on my iPad of the shownotes, and pasted the pictures into a Penultimate notebook.  I wrote my own notes on top of the shownotes while I listened.


To learn more about RSI drugs, I read the EM Lyceum posts on RSI pharmacology.  EM Lyceum links you to the primary literature to be able to intelligently form opinions on controversial topics yourself.

EM Lyceum
I realized quickly that every Web 2.o resource above referenced the clasic text, Walls' Emergency Airway Management.  I ordered it from amazon, and read it cover to cover. 

"The patient might have a head bleed, he needs to be intubated, but we don't want to raise his ICP," I said.  We'll use a weight of about 80kgs: give him 120mg of lidocaine and 250mcg of fentanyl .  Then push 25mg of etomidate, and 120mg of sux, in that order," I said confidently. 

I intubated him, gave him another 50mcg of fentanyl and started him on a 2mg/min propofol drip.  He was then rushed off to CT.

- Case 7-2 will discuss rapidly accessible bedside RSI resources for your phone or tablet

Case #6 – Face Block

Case #6: Face Block

A 38M presents to the ED after getting hit in the face with a treebranch while riding a bike downhill through the woods.  The patient has multiple superficial lacerations on his forehead, maxilla, and on the pinna of the ear.  No LOC or neurological deficits. CT of the face shows no bony injuries.  Tetanus UTD.

Web 2.0 Resources used:
EMProcedures
MedScape Procedures

This guy basically needed his whole face anesthetized.  My attending suggested I do a number of blocks, many of which I had never done.  I opened my free Medscape App on my iPad and surfed through the various blocks under the anesthesia tab.  I use this app for all procedures that I either have never done before or those I need a refresher for.  For the various blocks, the app provides good photos of entry points and also gives good nerve distribution maps.

After the shift, I watched the series of videos on EMProcedures given by EM residents at Mt. Sinai.  Through video, I learned the blocks I would need to anesthetize the entire face.  I booked-marked the site on my iPad and my phone.  Now I can pull them up at any time if I want to use video rather than written word and photos.

Case #6 – Face Block

Case #6: Face Block

A 38M presents to the ED after getting hit in the face with a treebranch while riding a bike downhill through the woods.  The patient has multiple superficial lacerations on his forehead, maxilla, and on the pinna of the ear.  No LOC or neurological deficits. CT of the face shows no bony injuries.  Tetanus UTD.

Web 2.0 Resources used:
EMProcedures
MedScape Procedures

This guy basically needed his whole face anesthetized.  My attending suggested I do a number of blocks, many of which I had never done.  I opened my free Medscape App on my iPad and surfed through the various blocks under the anesthesia tab.  I use this app for all procedures that I either have never done before or those I need a refresher for.  For the various blocks, the app provides good photos of entry points and also gives good nerve distribution maps.

After the shift, I watched the series of videos on EMProcedures given by EM residents at Mt. Sinai.  Through video, I learned the blocks I would need to anesthetize the entire face.  I booked-marked the site on my iPad and my phone.  Now I can pull them up at any time if I want to use video rather than written word and photos.

Case #6 – Face Block

Case #6: Face Block

A 38M presents to the ED after getting hit in the face with a treebranch while riding a bike downhill through the woods.  The patient has multiple superficial lacerations on his forehead, maxilla, and on the pinna of the ear.  No LOC or neurological deficits. CT of the face shows no bony injuries.  Tetanus UTD.

Web 2.0 Resources used:
EMProcedures
MedScape Procedures

This guy basically needed his whole face anesthetized.  My attending suggested I do a number of blocks, many of which I had never done.  I opened my free Medscape App on my iPad and surfed through the various blocks under the anesthesia tab.  I use this app for all procedures that I either have never done before or those I need a refresher for.  For the various blocks, the app provides good photos of entry points and also gives good nerve distribution maps.

After the shift, I watched the series of videos on EMProcedures given by EM residents at Mt. Sinai.  Through video, I learned the blocks I would need to anesthetize the entire face.  I booked-marked the site on my iPad and my phone.  Now I can pull them up at any time if I want to use video rather than written word and photos.