Here are some excerpts from Preoxygenation and prevention of desaturation during emergency airway management. [ PubMed Abstract] [Full Text HTML] [Full Text PDF] Weingart SD1, Levitan RM. Ann Emerg Med. 2012 Mar;59(3):165-75.e1. doi: 10.1016/j.annemergmed.2011.10.002. Epub 2011 Nov 3.
Be sure to visit Dr. Weingart’s outstanding resource page, Preoxygenation, Reoxygenation and Deoxygenation, which has great videos on how to implement the techniques discussed in the article
[But everyone needs to read and reread the complete article.]
RISK STRATIFICATION AND CONCLUSIONS Patients requiring emergency airway management can be risk stratified into 3 groups, according to pulse oximetry after initial application of high-flow oxygen. The recommended techniques to use for patients in each group are shown in Table 2, and a logistic flow of preoxygenation steps is shown in Figure 3. Head-elevated positioning is simple and easy to apply in all patients; in the patient immobilized for cervical spine injury, it is beneficial to tilt the foot of the bed downward. Patients at lowest risk (saturations of 96% to 100%) should be properly positioned and receive preoxygenation; active ventilation is not needed. Passive apneic oxygenation during tracheal intubation efforts may not be necessary in these lowrisk patients, but it will extend safe apnea in the event of repeated tracheal intubation attempts. Patients in the 91% to 95% saturation group after receiving high FiO2 levels are at high risk of critical desaturation during emergency tracheal intubation. Positioning, preoxygenation, and passive oxygenation should be used. For these patients, consideration should be given to using PEEP during preoxygenation and while awaiting muscle relaxation, but the risks and benefits of these techniques must be assessed case by case. For patients initially hypoxemic with high FiO2 levels (saturation of 90% or less), aggressive efforts must be made to maximize saturation before tracheal intubation. These patients will require PEEP during preoxygenation, ventilation during the onset of phase of muscle relaxants, and passive oxygenation during tracheal intubation. Videos of the techniques described in this article can be found at http://emcrit.org/preoxygenation.