RT Book, Section A1 Beed, Stephen A2 Hung, Orlando A2 Murphy, Michael F. SR Print(0) ID 55869914 T1 Chapter 27. Airway Management in the Intensive Care Unit T2 Management of the Difficult and Failed Airway, 2e YR 2012 FD 2012 PB The McGraw-Hill Companies PP New York, NY SN 978-0-07-162344-5 LK accessanesthesiology.mhmedical.com/content.aspx?aid=55869914 RD 2024/03/29 AB A grossly intoxicated and obese 52-year-old woman slips while leaving a restaurant, striking her head on a concrete step. She loses consciousness and while lying on her back vomits and aspirates. She is transported by ambulance to the emergency department (ED). By the time she reaches the ED, she is awake and complaining of difficulty in breathing. She is 5 ft (152 cm) tall and weighs 220 lb (100 kg). She has a heart rate (HR) of 122 beats per minute (bpm) (sinus rhythm on the cardiac monitor), respiratory rate (RR) of 28 breaths per minute (and labored), oxygen saturation (SpO2) 90% (on a non-rebreather), and a blood pressure 154/88 mm Hg. Computed tomography (CT) of her head is negative and she has no other injuries. The patient is admitted to the intensive care unit (ICU) for management of her aspiration pneumonitis. Following admission to the ICU, she becomes more distressed and her oxygen saturation falls into the low 80s despite optimal medical management and attempts at noninvasive ventilation. The decision is made to intubate the trachea of the patient. Airway evaluation reveals a thyromental distance of 4 cm; she has both upper and lower dentures. The initial attempt to intubate her trachea awake is unsuccessful and is complicated by further vomiting and aspiration. A second attempt employing a rapid-sequence intubation (RSI) technique, including Sellick maneuver is successful. During the intubation, particulate matter in the pharynx is noted. The laryngeal view with external laryngeal manipulation is a Cormack/Lehane Grade 2. Tracheal placement is confirmed with end-tidal carbon dioxide (ETCO2) detection. Bronchial lavage with a flexible bronchoscope (FB) is performed immediately after intubation.