Bariatrics Pt.! What would you do?

True.. .but rather not let it get to that point

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I cant disagree with him that RSI is an option...my avg t-port time is over an hour, sometimes more. And we used to rsi chf alot....before we had cpap....as for the cric, could do but last resort...consider retrograde before that...

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Short of SEVERE laryengospasm, there's no way I'm letting this lady even catch a whiff of a paralytic agent.

If she can be coached through it we'd do it awake. Preparation and positioning are key here.

If that doesn't work, we're probably going to end up cutting. I'd perfer a cric to a retrograde intubation though. If your putting a hole in the neck, why not just put a tube in it?
 
I'd perfer a cric to a retrograde intubation though. If your putting a hole in the neck, why not just put a tube in it?
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The main argument against a retrograde in this setting isn't the argument over putting a tube in subglottic versus transglottic but rather that we often won't have a long enough needle to perform a retrograde in a morbidly obese patient. This means you'd have to use a modified technique and at that point, you're right- just put in a cricothyrotomy.

The main reason retrograde intubations have their place is that a crike isn't a long term solution so the person either winds up trached formally or has an ETT passed down orally. Think of it as saving a step. LOL
 
usafmedic45 said:
The main argument against a retrograde in this setting isn't the argument over putting a tube in subglottic versus transglottic but rather that we often won't have a long enough needle to perform a retrograde in a morbidly obese patient. This means you'd have to use a modified technique and at that point, you're right- just put in a cricothyrotomy.

The main reason retrograde intubations have their place is that a crike isn't a long term solution so the person either winds up trached formally or has an ETT passed down orally. Think of it as saving a step. LOL
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Interesting thoughts, different angle with another host of issues...have we made it to the hospital yet?
 
Aside from giving a funeral director the heads up?

Other than the obvious (nitro, cpap etc), I'd be on the radio to the managers.

This character is crook and not going anywhere untill the bariatric ambulance arrives which could be shortly after next christmas. Obviously requires intensive care paramedics and the adult retrieval team might wanna come and fiddle about.

It would certainly be an interesting task to move a half ton intubated and ventilated pt.

I cant say I fancy the idea of intubation in this fella either, but I'm with Linus, if you've tried everything else in the book, and you have a crashing pt, who isn't going anywhere anytime soon, what else can you do?
 
Interesting thoughts, different angle with another host of issues...have we made it to the hospital yet?
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No, just making a point though for educational purposes.
 
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