Monday, June 13, 2011

Providing Fresh Air

I have yet another first to add to my list of many as I trudge along the med student life. Like many, this one is procedural. In emergency medicine the procedures continue to accumulate the longer you are there. I think it falls into the "see one, do one, teach one" mantra.

Rapid Sequence Intubation

With little success at my previous attempts, intubations were starting to concern me when I could only see the epiglottis and no vocal cords. That was the closest I came before patients would start to lose oxygen and the attending moved in to finish the job. After wondering why I was going to an extra shift last week, I was glad it fit into my schedule. We had a patient with respiratory distress needing rapid intubation. Despite their predetermined status as a "difficult" airway, my attending gave me the opportunity to perform the skill. Focused and determined to finally have a successful intubation, I meticulously placed the endotracheal tube on my first attempt...in the right place! In a specialty where airway management is critical and a career of it ahead of me, it is nice to see where my first success actually occurred.

The physician with whom I was working mentioned the day before, "you have to respect the difficult airway." Although I may not completely understand that statement at this point in my career, I know that the skill is important enough to appreciate pitfalls and workarounds. My extra shift turned out to be rewarding on this particular occasion. A simple procedure to some happened to be another milestone in my book.

Question of the Week
A dialysis patient has missed their routine treatment and is now currently in respiratory distress as a result. You choose to intubate the patient. In preparation for this procedure, the use of which of the following paralytic medications would be discouraged?

A. Succinylcholine
B. Rocuronium
C. Vecuronium
D. Pancuronium
E. Rapacuronium

Answer & Explanation

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