Airway FACTS

• Should I remove the nasal cannula (NC) prior to intubating once the patient is paralyzed?
  • NO
    • http://emcrit.org/preoxygenation/
    • https://umem.org/educational_pearls/1702/
    • http://www.epmonthly.com/archives/features/no-desat-/
    • http://www.acep.org/uploadedFiles/ACEP/MeetingSites/PEM/Educational_Programs/Gausche-Hill%20-%20High%20Flow%20Nasal%20Cannula%202013%20rev.pdf
  • “Apneic oxygenation” allows for continuos oxygenation through a passive process driven by oxygen gradients in the alveoli that are still performing their function of gas exchange.
• Can I can rely on a finger pulse oximetry probe for current oxygenation information?
  • NO
    • http://www.ncbi.nlm.nih.gov/pubmed/22305148
    • http://www.ncbi.nlm.nih.gov/pubmed/20858133
    • http://emcrit.org/podcasts/oxygen-physiology/
    • http://www.mdlinx.com/emergency-medicine/news-article.cfm/3929916/head-injuries-closed
    • https://didacticsonline.com/2013/08/11/monitoring-critically-ill-patients/
  • Pulse ox results can lag anywhere from 30 seconds to 3 minutes depending on cardiac status of patient.  Ear probes can provide more current information due to their lack of vasoconstriction and central blood supply.