Episode 54: Preoxygenation and Delayed Sequence Intubation

Hot on the heels of Dr. Scott Weingart's latest publication in the Annal of EM on Preoxygenation & Delayed Sequence Intubation, we have Dr. Weingart, perhaps the world's most influential critical care educator, and Dr. Walter Himmel, 'The Walking Encyclopedia of EM' discussing how the community ED doc can use preoxygenation, apneic oxygenation and delayed sequence intubation to help improve airway management knowledge and skills. Whether you work in a rural setting or a big urban community hospital, Dr. Himmel and Dr. Weingart explain how these concepts and skills are easily adaptable to your work environment. We introduce the Triple 15 Rule for preoxygenation as a memory aid that will help you the next time you're faced with a critically ill patient who's oxygen saturation isn't good enough on a non-rebreather.



Written Summary & Blog post prepared by Dr. Keerat Grewal, edited by Dr. Anton Helman November 2014

Cite this podcast as: Helman, A, Weingart, S, Himmel, W. Preoxygenation and Delayed Sequence Intubation. Emergency Medicine Cases. November, 2014. https://emergencymedicinecases.com/episode-54-weingart-himmel-sessions-preoxygenation-delayed-sequence-intubation/. Accessed [date].

Go to part 2 of this 2-part podcast on critical care

Preoxygenation Strategies

Preoxygenation prior to intubation is required to de-nitrogenate the patient’s lungs and to prevent desaturation during the apneic period after induction and paralysis, and during intubation.

Traditionally with Rapid Sequence Intubation (RSI), the patient is pre-oxygenated for 3 minutes of tidal volume or 8 vital capacity breaths with a non-rebreather. This only supplies an FIO2 of approximately 60%.

Consider adding nasal prongs with 15L of supplemental oxygen to 15L of O2 through the non-breather to increase the FiO2 closer to 100%.

Elevate the head of the bed to 20-30 degrees to optimize gas exchange. This also helps improve visualization during intubation. If the patient is in spinal precautions, use the reverse trendelenberg position.

If the patient is still hypoxic with these maneuvers (O2 saturation