Post Conference Learning Points
August 12th, 2009 at 5:54 pm by LisaThanks to Dr. Leung for her expertly-presented M&M case this morning.
Teaching points from the case:
* Patients with upper GI bleed are at high risk to vomit and aspirate before and during intubation. An NG tube may decrease the likelihood of aspiration and is not contraindicated in variceal bleeding.
* When intubating a patient with upper GI bleed, extra precautions should be taken to avoid regurgitation and subsequent aspiration. Consider intubating with the head of bed at 30 to 45 degrees.
* Bag-valve-mask ventilation is ideally avoided in these cases, as insufflating the stomach is particularly dangerous. Maximize your chance of success on the first pass of laryngoscopy by optimizing preparation and technique, using an experienced operator initially. Additionally, an airway management adjunctive device (such as the glidescope) may be valuable to use initially.
* Despite the value of avoiding BVM, if laryngoscopy is not generating an adequate view, abandon that attempt early so that BVM may be performed gently and slowly, ideally with oral and nasal airways in place, to minimize insufflation of the stomach. Bagging via LMA is an even better approach.
* Use a bougie immediately if only part of the vocal cords are seen or if there is trouble passing the tube through the cords.<
* Aspiration of gastric contents is a chemical and not an infectious pneumonitits; antibiotics are not indicated initially.
Posted in Post-Conference Letter, GI | No Comments »
