Anaesthesia Coffee Break

How do you PREVENT HYPOXAEMIA when performing a rapid sequence induction (RSI)?

Jan 24, 2021
Explore the techniques to prevent hypoxaemia during rapid sequence induction. Learn about the physiological mechanisms behind pre-oxygenation and the risks involved, including absorption atelectasis. Discover how patient positioning can enhance intubation success while also posing hypotension risks. Delve into the benefits of nasal high-flow oxygen during apnoea and the debate on bag-mask ventilation. Finally, uncover the controversies surrounding cricoid pressure and its actual benefits in practice.
Ask episode
AI Snips
Chapters
Transcript
Episode notes
ADVICE

Pre-oxygenate To Increase Safe Apnea Time

  • Pre-oxygenate with a tight face mask at 100% O2 until end-tidal O2 >80% or for ~5 minutes.
  • Mention absorption atelectasis and rare oxygen toxicity and that pre-oxygenation time may delay induction.
INSIGHT

Hypoxaemia Driven By Few Key Mechanisms

  • Hypoxaemia arises from decreased FiO2, hypoventilation, V/Q mismatch, shunt and diffusion defects.
  • Prevent it by increasing or preserving oxygen stores (safe apnea time) before intubation.
ADVICE

Use PEEP/CPAP To Boost FRC

  • Apply PEEP/CPAP during pre-oxygenation to increase FRC and reduce shunt.
  • Watch for increased dead space, excessive airway pressure and potential gastric insufflation if pressures are high.
Get the Snipd Podcast app to discover more snips from this episode
Get the app