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RSI • General anaesthesia induced by a rapid acting IV induction agent and a rapid acing muscle relaxant with application of cricoid pressure • 7P • Preparation • prepare all necessary equipment, drugs and back-up plans • Preoxygenation • with 100% oxygen, replace nitrogen in the functional residual capacity (FRC) of the patient's lung with oxygen. • Premedication • depending on the patient • Paralyze +induction of anaesthesia • Suxamethonium, thiopentone, etomidate, ketamine… • Pass the tube • visualize the tube going through the vocal cords • Proof of placement • Post intubation care • secure the tube, ventilate 16
• RSI • Suxamethonium 75mg • Etomidate 15mg • Size 7.5ETT at 22cm first go • Post intubation • CXR • Bilateral diffuse lung fibrosis, no pneumothorax, ETT in situ. • SaO2 99% • ETCO2 38 • BP 142/100mmHg P 127 • ICU consulted • unlikely l to benefit from ICU care • Admitted to general ward 17
Page 1 and 2: Case presentation Dr. W.S. Ng Dr. K
Page 3 and 4: • On arrival, vital signs • BP
Page 5 and 6: Proceed to RSI for mechanical venti
Page 7 and 8: • Approach by ABC • P/E • Tac
Page 9: Investigations • ECG • At Arter
Page 13 and 14: Sliding sign Comet tail artifact 13
Page 15: Now patient got Type 2 respiratory
Page 19 and 20: Progress • Extubate on the same d
Page 21: • PHx. • Retired businessman
Page 26 and 27: Pulmonary Fibrosis 26
Page 28 and 29: Diagnosis • Progressive shortness
Page 30 and 31: Treatment • limited treatment opt
Page 32 and 33: Now you know the history and DNR Wi
Page 34 and 35: HAHO guideline on in-hospital resus
Page 36 and 37: DNR Ambulance Command Standing Orde
Page 40 and 41: • Ambulance Command Standing Orde
Page 42 and 43: • Advance Directives (AD) • Bac
Page 44 and 45: • Advanced Care Plan (ACP) • A

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