Fall from a roof

[Handsome Robb]

Thanks JT, Thats what I was looking for. I'm just wondering if I'm just reading into it too much and thinking that its more complicated than it actually is? Or if it is actually as complicated as I think?

I know how the waves are supposed to look and I have a general idea of what each part of the wave means, is there more to it than that?

 

[TransportJockey]

That's the basics, there's always mroe to learn
http://emscapnography.blogspot.com/
That's a good reference on capno that I have looked over before and probably will again.

 

[Handsome Robb]

Awesome thanks for that link thats very interesting.

So back to talking about ETTs and raising the ICP. In a situation such as the one in this scenario would it be appropriate to use a bougie to place the tube? The bougie eliminates the need for laryngoscopy, which causes the increase in ICP correct? Or am I completely off point with this thought process?

 

[Smash]

Awesome thanks for that link thats very interesting.

So back to talking about ETTs and raising the ICP. In a situation such as the one in this scenario would it be appropriate to use a bougie to place the tube? The bougie eliminates the need for laryngoscopy, which causes the increase in ICP correct? Or am I completely off point with this thought process?

Sorry, I am slow. The bougie doesn't eliminate the need for laryngoscopy, it is used when you have a difficult airway, like a grade 3 or 4 view (Google Cormack-Lehane to see what that means) as it is easier to place than an ETT and gives some non-visual cues if you are in the right hole or not. It can indeed be place "blind" but the best way to intubate is still under direct view.

If RSI is carried out properly there shouldn't be too much of an impact on ICP. An opioid (usually fentanyl, but sufentanil, remafentanil or even at a pinch, morphine) is usually given as part of the process. The rationale is that opioids inhibit or even eliminate (depending on dose) the sympathetic repsonse to laryngoscopy that causes the rise in ICP. There is some conjecture whether it is clinically significant, but it is not an unreasonable rationale and probably causes no harm.

There is no evidence that lidocaine is any use, and some people mistakenly think that a small dose of non-depolarizing agent is also used for ICP management: it's not, it was thought to reduce muscle soreness in patients who were only going to be under for a short time. It doesn't and that isn't who we are RSI-ing anyway.

Clear as mud?