Airway management is a critical skill for every clinician. Dr. Mellick’s YouTube video, Pediatric Laryngoscope Blade Length Selection, addresses an important technical consideration.
However, it is critical to remember that an intubation in a patient who is still breathing adequately can turn a bad situation into a disaster.
The induction agent used for the RSI can decrease sympathetic drive which may be keeping the blood pressure up. Also positive pressure ventilation has a negative effect on venous return which can also lead to a serious drop in the blood pressure.
So think very carefully in the hypotensive patient or the normotensive patient in compensated shock or who is hypovolemic (from sepsis [or another distributive problem], trauma, or dehydration).
If circumstances force you to intubate, then be ready to counteract hypotension with your already prepared premixed syringe of pulse dose pressor. *
*Please review the outstanding notes of Episode 50 Recognition and Management of Pediatric Sepsis and Septic Shock from Emergency Medicine Cases. These detailed notes and the accompanying podcast link have everything you need to remember about hypotension even though it only considers septic shock – the warnings and helps apply to other causes of shock.
And please review these additional resources from Dr. Mellick:
*Dr. Mellick’s Vid: Pulse Dose Epi–Intubating the Unstable Patient (Watch and Read!) Posted on January 10, 2014 by Tom Wade MD
*Another Great YouTube Video from Dr. Mellick–Pediatric Pulse Dose Pressor Administration Posted on October 2, 2014 by Tom Wade MD
And finally this post with notes from and links to Dr. Weingart’s outstanding lecture:
*Vasopressor Basics (and Much More)–#138 from Dr. Weingart
Posted on May 25, 2015 by Tom Wade MD