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For which of the following pediatric patients is it most important to have the clinician with the most experience in advanced airway management and endotracheal intubation perform rapid sequence medication-assisted intubation?
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November 21, 2019 at 4:22 pm
E) Severe DKA patient
While all of these patients may present challenges for endotracheal intubation, the best answer is the patient with severe DKA. This patient is likely hyperventilating down to a low PCO2 as compensation for the severe metabolic acidosis of DKA. Paralysis during RSI leading to apnea results in a loss of that compensation, and may result in a drop in the patient’s already dangerously low pH level, precipitating arrest, especially if the intubation attempt is prolonged. The newly born infant may be difficult to intubate for those less experienced, due to anatomical differences from older patients, but these babies can often be successfully managed with BVM between attempts. Septic patients who are hypotensive should be adequately fluid resuscitated prior to giving RSI medications and initiating positive pressure ventilation, both of which may exacerbate hemodynamic instability, but this caveat is not related to the experience of the intubator.