#206 Airway Management for the Non-Intensivist
Breathe easy with these airway management principles and expert tips for managing the patient with COVID-19 related lung disease (i.e. pneumonia, hypoxemia, ARDS). In the COVID-19 era, non-intensivists are being called upon to care for critically ill patients across the globe. At the Curbsiders, we understand that this can be a stressful proposition! Therefore, we’ve enlisted the help of the renowned medical intensivist & USUHS Chair of Medicine, Dr. Kevin Chung (@chungk1031) to teach us what we need to know about airway management in these challenging times.
- Written and Produced by: Cyrus Askin MD, Michael Rose MD, Kathleen Hiltz MD
- Show Notes: Cyrus Askin MD
- Infographic: Elena Gibson, MD
- Cover Art: Dr. Kate Grant MBChB DipGUMed
- Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP; Cyrus Askin, MD
- Editor: Matthew Watto MD, FACP (written materials); Clair Morgan of nodderly.com
- Guest: COL Kevin Chung, MD, FACP
AccessMedicine is the acclaimed online medical resource that features Harrison's Principles of Internal Medicine and more trusted content from the best minds in medicine. Visit AccessMedicine to learn more: http://bit.ly/MHCurbsiders.
- 00:00 Sponsor - AccessMedicine by McGraw Hill http://bit.ly/MHCurbsiders
- 00:15 Disclaimer, intro, guest bio
- 03:15 Guest one liner, chicken wings (Miller Lite marinade), career advice
- 07:40 Sponsor - AccessMedicine by McGraw Hill http://bit.ly/MHCurbsiders
- 08:20 Case of hypoxemic respiratory failure; Rapid evaluation, initial labs
- 16:03 Initial assessment of a COVID-PUI; HFNC and non-invasive ventilation
- 23:40 Proning patients for hypoxemia
- 29:15 ARDS basics: diagnostic criteria, Brief Recap
- 33:22 Mechanical ventilation: Initial settings, following the blood gas
- 40:55 Peak and plateau pressure, Lung compliance and Troubleshooting a high pressures
- 51:30 Ventilator dyssynchrony; Lung compliance and traditional ARDS vs COVID-19 lungs
- 62:55 Advanced ARDS - The 5 Ps of therapy and differences with COVID-19
- 68:10 Take home points; Plugs; Outro
- Internet Book of Critical Care (IBCC) Podcast by Dr. Josh Farkas - COVID-19
- Dr. Jessica Bunin’s Video Lecture on Vent Basics for Non-Intensivists
- COVID-19 Toolbox
- One-Stop for some COVID-19 video content, also on the COVID-19 Toolbox Site
Listeners will be equipped with the basics to provide ventilatory support, to include the use of mechanical ventilation, for critically ill patients in the COVID-19 era.
After listening to this episode listeners will…
- Appreciate the unique challenges faced by the medical community as pertaining to the current COVID-19 pandemic.
- Be familiar with fundamentals of critical care as pertaining to airway management.
- Define the diagnostic criteria of ARDS and appreciate early clinical signs that may indicate a patient is developing ARDS.
- Review the various non-invasive methods of assisting with oxygenating & ventilating a patient (NC, NRB, HFNC, NIPPV, etc.) and any key contraindications.
- Recognize signs suggestive of impending respiratory failure requiring invasive mechanical ventilation (i.e. indications for intubation).
- Be familiar with basic ventilator parameters, basic terminology / modes.
- Know initial vent settings for a patient with resp failure / ARDS based on ARDSnet data.
- Have an approach to titrating vent settings based on physiologic parameters & the blood gas.
- Know special considerations for management of ARDS in a patient with COVID-19.
- Be familiar with advanced management strategies for patients with ARDS such as proning and paralysis
Dr. Chung reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.
Chung, K, Askin C, Rose M, Hiltz K, Gibson E, Williams PN, Watto MF. “206 Airway Management for the Non-Intensivist”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list 04/13/2020.\