A novel technique to intubate patients without reliable pulse oximetry - 15/10/18

Doi : 10.1016/j.ajem.2018.07.038

Tony Zitek, MD ^a,^b,^{^⁎} , Ross P. Berkeley, MD ^a,^b, Ryan Hodnick, DO, NREMT-P ^c,^d, Ken Davis, BA, EMT-P, FP-C ^e, Noam Dadon ^f, David E. Slattery, MD ^a,^b
^a University of Nevada, Las Vegas School of Medicine, Department of Emergency Medicine, 901 Rancho Lane, Las Vegas, NV 89106, United States of America
^b University Medical Center of Southern Nevada, Department of Emergency Medicine, 1800 W Charleston Blvd, Las Vegas, NV 89102, United States of America
^c MedFlight, 2301 Yale Blvd SE # D3, Albuquerque, NM 87106, United States of America
^d Santa Fe Fire Department, 200 Lincoln Avenue, Santa Fe, NM 87504-0909, United States of America
^e EMSRx, Eastern New Mexico University, Roswell, United States of America
^f University of Nevada, Las Vegas, 4505 S Maryland Pkwy, Las Vegas, NV 89154, United States of America

^⁎Corresponding author at: 901 Rancho Lane Ste 135, Las Vegas, NV 89106, United States of America.901 Rancho Lane Ste 135Las VegasNV89106United States of America

Abstract

Although advances have been made in the approach to airway management, intubating critically ill patients in the Emergency Department (ED) can still be perilous. In some cases, poor peripheral perfusion may preclude obtaining a consistent or reliable pulse oximetry waveform, and the intubator will not accurately know when the patient begins to desaturate. We describe a case of a patient requiring intubation in whom we were unable to obtain a consistent pulse oximetry waveform. We utilized a novel technique in which a Biphasic Cuirass Ventilation (BCV) device was applied to maintain oxygenation and ventilation during the performance of rapid sequence intubation (RSI). This technique has the potential to improve the safety of RSI, especially in the critically ill patient.

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Keywords : Intubation, Emergency airway management, Pulse oximetry